Parents of children treated outside the full list are at risk of getting worse if they lack special care; “We need more solid evidence,” the lawyer said Parnambuko

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Patients who were denied procedures, tests, surgery and unlisted drugs can go to court and get this coverage. With change, court decisions must follow the understanding that there is no need to cover what is not on the list (see below).

Christian Oliveira, mother of Joao Lucas and Jose Bernardo, says her children receive adequate multidisciplinary treatment through a ban. “Even after accepting many sacrifices and providing health insurance, we had to go to court to ensure they received adequate treatment,” he said.

Christian says he doesn’t know how to act from now on. “We do not know what is going to happen. Because, nowadays, what is indicated in the ANS list is not the proper treatment for our children and is needed for the development of thousands of autistic people,” he said.

For Vanessa Martins, the mother of Joao Guilharm, it is sad to want the best treatment for her son and not be able to do so.

“We’ve already worked hard to pay for the plan to give him a better life. I don’t know how his surgery will be from now on, whether the plan will cover it. We have to fight in court now to prove that, in fact, my son needs therapy.” , Which is really good for my son and it is very painful, “he said.

Renata Falcao, Dante’s mother, fears her son will lose his medical progress – Photo: Reproduction / TV Globo

Renata Falcao, Dante’s mother, said her son had not interacted with the other children, told them all to leave and that he was fine wherever he came today. He fears that he will not be treated and that all progress will be lost.

“He’s where he is today because of the therapy he’s been doing since he was two and a half years old. And I’m losing my son’s quality of life, my son’s future security,” Renata declared.

The mother of the boy with microcephaly said the ministers did not know what it was like to go to the SUS line

The mother of 6-year-old Guilherm, who has microcephaly and autism spectrum disorder, received a call from the health plan while following the STJ vote on Wednesday (8). He was even more upset when a health planner said he would check if the ANS was on the list of the therapeutic intensive care he had ordered for his son.Watch the video above)

“The poor who are born in Brazil are condemned. We live in a country where money is more important than life. These ministers do not know what it is like to line up for SUS. [Sistema Único de Saúde] In the morning, wait a few months, “said Germany.

Challenges for family members and lawyers

The expert explains the decision about the health plan and the ANS list

The expert explains the decision about the health plan and the ANS list

According to lawyer Viviane Guimarães, health rights expert and people with disabilities, most therapies, treatments and technologies are not included in the ANS list. (Watch the video above).

“It will be a real challenge from now on. An additional challenge because it is already a challenge for families and for those of us who are lawyers to make the right decision to guarantee these treatments,” said Vivienne.

The lawyer further explained about this Health plans have already denied treatment when the list was considered exemplary, but other methods may be covered since the judge had a favorable understanding that it was exemplary.. He said to get a favorable decision in court, it would be more complicated.

“We need stronger evidence. Doctors need to make more detailed reports to show the scientific evidence of that treatment, why, if that treatment does not exist in SUS, if all the treatment possibilities are listed. So, from what we do today, we We need to develop a different strategy, “said Vivian.

Health plan: What changes may be made to coverage with STJ judgment

Health plan: What changes may be made to coverage with STJ judgment

According to the STJ’s decision, health plan operators are not required to cover procedures that are not on the ANS list. This decision includes coverage of tests, therapy, surgery and drug supply, for example. (Watch the video above).

Six of the nine ministers who voted in the second round realized that the so-called list of ANS methods was complete – that is, the list contained not only examples, but all coverage obligations for health planning.

STJ’s decision does not compel other instances to follow this understanding, but the judgment serves as a guideline for justice. STJ’s understanding represents a change in the law that was applied by most courts in the country, the list of which was just one example.

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