Dos impactos causados no setor de saúde suplementar pela mudança de entendimento (overruling) do Superior Tribunal de Justiça acerca do rol de procedimentos da Agência Nacional de Saúde

Abstract

The overruling of the Superior Court of Justice regarding the character of the list of procedures of the National Supplementary Health Agency (ANS), after the judgment of RESP No. 1,733,013 / PR, which had Minister Luís Felipe as rapporteur Solomon, has brought about significant changes in the country's supplementary health sector. Until then, it was considered that the list was merely exemplary, serving only as a mere parameter to be followed by health insurance companies regarding the mandatory minimum coverage. However, after the judgment of the aforementioned appeal by the 4th Panel of the Superior Court of Justice, in which several entities participated as amicus curiae, the understanding of the Superior Court underwent modification through the mechanism called overruling, adopting the concept of that the List of Procedures of the ANS is mandatory. This new conception is already being introduced in judgments across the country, although there is still a rejection on the part of the hitherto majority majority, demanding that the referred subject be the subject of future debates by specialists in the area, in order to avoid insecurity legal. In this vein, this monograph aims to analyze the impact that this decision can have on the lives of health plan users and how the entire supplementary health sector has been reacting to such changes. Thus, the present study, which used bibliographic and documentary research as methodology, will begin with a description of the general notions of the constitutional right to health, inscribed in the 1988 Constitution as a duty of the State, with the exploitation of the provision of this health supplementary way by health plan operators, which are regulated by Law No. 9,656 / 98, the so-called Health Plan Law (LPS). Then, the aspects inherent to the role of ANS in the sector will be outlined, mainly in relation to the aforementioned List of Procedures. At the end, it is exposed how the change in the STJ's understanding may impact the treatment of users, without forgetting the aspects related to the maintenance of contractual balance and the actuarial health of the operators.