As recusas dos planos de saúde quanto aos tratamentos para pessoas com transtorno do espectro autista: compreendendo as repercussões do atendimento do Superior Tribunal de Justiça

Abstract

The theme of this research concerns the repercussions of the understanding of the Superior Court of Justice of Special Appeal 2,043,003 regarding the refusals of health plans to treat people who are within the autism spectrum. Patients with ASD face denials of coverage for essential therapies, such as ABA (Applied Behavior Analysis) psychotherapy, restrictions on the number of treatment sessions and other forms of assistance, even when prescribed by their treating physicians when seeking contractual coverage from their plans. private healthcare. It is often necessary to appeal to the Judiciary to obtain this coverage, raising questions about the legality and effectiveness of these patients' right to health. In 2023, the Superior Court of Justice analyzed Special Appeal 2,043,003, stipulating that health plans should provide comprehensive coverage for multidisciplinary treatment of people with autism. This study's general objective is to understand the repercussions of the Superior Court of Justice's understanding of health plan refusals regarding treatments for people on the autism spectrum. And the specific objective of the first chapter is to describe the definitions and characteristics of Autism Spectrum Disorder from its historical context. The second specific objective is to describe the rights that the Consumer Protection Code guarantees to health plan users. And the third specific objective is to analyze the decision of the Superior Court of Justice (STJ) on expanding the list of the National Supplementary Health Agency (ANS) for people who are within the autism spectrum. The research methodology was the hypothetical-deductive method, based on bibliographical research on legislation, scientific articles, doctrines, jurisprudential research and documents related to the topic.