JURISPRUDENTIAL EXAMINATION IN APPLICATION OF THE ANS PROCEDURES LIST PAID BY HEALTH PLAN FOR TREATMENT OF AUTISTIC CHILDREN IN RIO GRANDE DO SUL AND CEARÁ

Abstract

The present work deals with the application of the list of procedures of the National Supplementary Health Agency (ANS) funded by a health plan for the treatment of autistic children, through the examination of decisions handed down in the second degree in the Courts of Justice of the states of Ceará and Rio Grande do Sul. It started from the following research problem question: What is the understanding of the Court of Justice of Rio Grande do Sul and the Court of Justice of Ceará regarding the list of procedures indicated by the National Supplementary Health Agency on requests for treatments for autistic children paid by plans of health before and after the decision of the STJ? It presents as a general objective to compare the understanding of the TJRS with the understanding of the TJCE regarding the list of procedures of the National Supplementary Health Agency in requests for treatment for autistic children funded by the health plan in the period from 06/08/2021 to 10/08/2022. For the present study, a qualitative and quantitative approach was used, examining judgments before and after the decision of the STJ. The deductive method was also used. As a result, even before the STJ judgment, the TJRS judges based their decisions on the argument that the list is exhaustive while the TJCE judges based their decisions on the argument that the list is merely exemplary. In the end, it is concluded that the hypothesis for answering the problem was confirmed, as there are differences between the courts regarding the list of procedures indicated by the ANS even after the STJ decision.