Post by account_disabled on Mar 13, 2024 0:54:42 GMT -8
Post-bariatric surgeries to remove excess skin are reparative in nature, not merely aesthetic. With this understanding, the 3rd Panel of the Superior Court of Justice denied a special appeal and maintained the obligation of health plans to cover such procedures.
For STJ, skin removal surgeries are restorative in nature
In 2011, the Public Defender's Office of Rio de Janeiro filed a public civil action asking that six health plans be forced to bear the costs of surgical interventions necessary to continue the treatment of morbid obesity, such as mammoplasty and abdominal, brachial and crural dermolipectomy. (for removing skin on the abdomen and arms and legs).
The Rio de Janeiro Court of Justice B2B Lead accepted the Defender’s request. After that, the National Supplementary Health Agency (ANS) established surgery coverage for all plans.
Amil, Unimed-Rio, Bradesco-Saúde, Banco do Brasil Employees' Assistance Fund, Full Health Assistance Association (Pame) and the Rio de Janeiro Hospital Group filed a special appeal with the STJ.
The 3rd Panel of the STJ denied the REsp. For the ministers, the surgeries are restorative in nature, and not merely aesthetic. Therefore, they must be covered by health plans.
Paradigm shift
Members of the Public Defender's Office of Rio de Janeiro state that the decision is important for valuing the right to health in Brazil.
"This is a very important victory, both for the expansion of the right to health and for the magnitude of the beneficiaries. And, in particular, against the largest health plans in Brazil. This is one of the reasons for the good management of collective actions by the Public Defender's Office of Rio de Janeiro", highlights public defender Pedro Carriello, representative of the institution in Brasília.
The coordinator of the Consumer Protection Center of the Public Defender's Office (Nudecon), Patricia Cardoso, highlights that the federal government only began to demand such an obligation from health plans after the Rio Public Defender's Office took action.
"Only after the filing of the public civil action by the Public Defender's Office — and successive victories in court — did the ANS include post-bariatric reconstructive surgery as mandatory. Being able, through an action by Nudecon, to make an impact on regulation and benefit all consumers of supplementary health in the country, it is a great victory". With information from the DP-RJ Press Office.