What should you do if you find it difficult to access health treatments? Understand

As medicine advances, countless innovative treatments for serious and degenerative diseases emerge. However, although they represent hope for many patients, these treatments often become inaccessible due to their high cost, causing frustration and suffering.

Lawyer Renata Frias, a specialist in health law at Crivelli Advogados, points out that this reality is no different for patients with health insurance. Although many treatments are approved by the National Health Surveillance Agency (ANVISA), health companies often refuse to cover the costs, claiming that they are not included in the list provided by the ANS.

However, the courts have ruled that the health insurance companies' refusal is abusive, as it is up to the doctor, and not the health insurance company, to decide on the best treatment for the patient. For this reason, judges have issued injunctions to guarantee access to these treatments, understanding that citizens' lives cannot wait.

Renata Frias stresses the importance of seeking legal help when treatment is denied, whether by the Unified Health System (Sistema Único de Saúde - SUS) or by the medical plan. She explains that the patient needs to present documents such as a detailed medical report, medical records and the denial of coverage of the treatment by the SUS or the health insurance company in order to file a lawsuit.

Faced with this scenario, advocacy for life becomes fundamental, ensuring that patients have access to the treatments they need to preserve their health and quality of life.

What do you do when a patient experiences this difficulty?

Faced with a refusal of treatment, either by the SUS or by the medical insurance, the patient should seek legal counsel to obtain authorization to pay for the treatment. All that is needed is for the disease to be included in the International Catalog of Diseases (ICD) and for the treatment or medication to be registered with Anvisa. To file the lawsuit, in addition to personal documents, the patient must submit:

• A detailed medical report containing the diagnosis, clinical history and therapies carried out and, finally, the prescription for the treatment/medication, demonstrating that the prescription is essential and failure to provide it could lead to the disease worsening.
• Copy of medical records
• Denial of treatment cover