Issue 725: The New Rule of Health Insurance

Talita Negri and her 3-year-old daughter are traveling nearly 1,000 kilometers to get the proper treatment for their health problem. To help Victoria, who has microcephaly with a motor and mental disability, she went to court and demanded that the Medicaid company fund the cost of clinics and specialists. “Today, she can stand on her own,” Talita boasts in a statement to the topic team. Such stories may become rarer after the STJ determined, in a 6-to-3 ratio, that the National Supplemental Health Agency’s list of actions should be considered comprehensive. That is, health plans are exempt from providing any treatment or treatment not on the ANS list. However, Dr. Ligia Bahia points out, there is a “comma” in the text that allows exceptions. In an interview with Julia Doilipe, professor and coordinator of the research group on collective health at UERJ explains why judges for the first and second trials should “recognize abuses and absurd interpretations” of health plans. However, it is concerned about the “grand extortion” that companies use to justify price hikes and influence the decisions of the ANS – whose role is to defend consumer rights, but which is “blatantly” on the other side. She also talks about the strain such a measure could place on the unified health system: “The SUS was for the poor and the health plans were for the poor.”

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Podcasts by: Mônica Mariotti, Isabel Seta, Tiago Aguiar, Lorena Lara, Gabriel de Campos, Luiz Felipe Silva, Thiago Kaczuroski, Gustavo Honório and Eto Osclighter. Presentation: Renata Le Pretty.