One of the biggest challenges faced by people with autism spectrum disorder is ensuring that their health insurance plans cover their treatment as prescribed by their doctor. Limitations on the number of therapy sessions and lack of coverage for specific treatments are some of the obstacles faced by beneficiaries.
The courts’ understanding lately is to consider contractual clauses that restrict the treatment of a certain disease abusive, ensuring that the procedure indicated by doctors is provided by the plans.
If in practice beneficiaries encounter any refusal or barrier presented by the plans, it is important that they try to resolve the impasse amicably and gather evidence of the refusal to seek legal assistance if the treatment is denied.
On this topic, it is worth noting that an appeal is pending judgment in the STJ, which will assess whether the ANS list is exhaustive or merely illustrative.
