The Second Section of the Superior Court of Justice (STJ) suspended, this Wednesday (23), the judgment of the appeals that deal with clarification on the list of mandatory coverage procedures, established by the National Health Agency (ANS), to be exhaustive or exemplary.
That is, health plan operators may or may not be required to cover unrelated procedures. So far, the score is 1 to 1. The votes of eight ministers remain. The trial must resume within 90 days.
The case was reconsidered this Wednesday, with the vote of Minister Nancy Andrighi, who defended the thesis that “the list of procedures and health events of the ANS has an exemplary nature”, that is, it can be expanded to cover of more treatments and procedures when necessary.
“Freedom to contract puts operators in a position of dominance over users of health plans, therefore, the intervention of the law is crucial, due to the action of the judiciary to protect weak users from any abuse practiced by strong operators and allow material balance between the contractors,” said the minister.
However, minister Villas Boas Cueva asked for a view after the rapporteur minister Luis Felipe Salomão made an amendment to the vote – more arguments about the process under discussion. The president of the session, Minister Antonio Carlos Ferreira, agreed with the collegiate a request for a collective view, which will be the last request for more time for analysis.
The rapporteur, even keeping the vote, stated that treatment with technical and adequate recommendation, there is an exception to the list. For him, each case, each situation must be analyzed in the “same systematics.”
“As a rule, role has a purpose, and the presumption is that it is legitimate and must be respected. I proposed the thesis that, as a rule, the role is exhaustive, except for exceptions such as this one,” concluded Salomão.
In one of the resources, the author, with severe depression and schizophrenia, claimed coverage of the Transcranial Magnetic Stimulation (TMS) treatment, prescribed by the psychiatrist.
The current understanding, more permissive to consumers, has prevailed for more than 20 years in the country’s courts, which are predominantly in favor of a broad interpretation, considering the list of procedures as a minimum or exemplary reference.
Source: CNN Brasil
