The Superior Court of Justice (STJ) considered abusive, for the second time, the denial of health plan coverage of the treatment considered appropriate for patients with autism, reaffirming the jurisprudence of the 3rd Panel of the STJ in the sense of the exemplary character of the list of procedures. The decision took place this Friday (6).
In a special appeal judgment against the judgment of the Court of Justice of Rio Grande do Norte (TJ-RN), Minister Ricardo Villas Boas Cueva dismissed Unimed Rio’s request and decided that the health plan must offer the appropriate treatment indicated by the professional. enabled and also indemnify the user for moral damages.
It is stated in the case file that the author was diagnosed as having an autism spectrum disorder, requiring multidisciplinary treatment with psychology, psychopedagogy, occupational therapy and speech therapy using the ABA and PAC methods. The treatment was denied on the grounds that there would be a restriction on the provision for this coverage in the list of procedures of the National Supplementary Health Agency – ANS and that there cannot be coverage of unlimited sessions.
On the 28th, the Federal Public Ministry (MPF) issued a recommendation to the National Supplementary Health Agency (ANS) to adopt measures to guarantee the proper care of children with Autism Spectrum Disorder (TEA) by the Unimed Natal health plan.
The office of Airton Ferraz Assessoria Jurídica acted in the defense of the patient. “After controversy regarding the STJ’s understanding of the ANS coverage list, the Court once again decided on the mandatory coverage by health plans of the appropriate treatment for Autism, affirming this obligation, as well as the duty to indemnify the user. of the health plan for moral damages due to its denial”, highlights the lawyer Airton Romero de Mesquita Ferraz.