Rol de procedimentos e eventos em saúde suplementar: uma análise acerca dos impactos sofridos pelas operadoras de planos de saúde e seus beneficiários frente a promulgação da lei n. 14.454/22 e o julgamento do STJ (Resp 1886929 e Resp 1889704)

Abstract

This paper has as its main objective to develop an analysis of the divergent interpretations within the Brazilian judiciary about the applicability of the procedure list of the National Health Agency (ANS). In this vein, we seek to demonstrate, through the comparative method and case analysis, the impacts suffered by the entire supplementary health sector due to the high rate of lawsuits filed against these institutions, as well as the most recent jurisprudential positions adopted on the theme by the Superior Court of Justice (REsp 1886929 and REsp 1889704) and the publication of Law 14454/22. Thus, the first chapters are responsible for unraveling the historical evolution of health care in Brazil, from the first resources to the trajectory for the consolidation of the Unified Health System (SUS) and later the first private assistance plans in the market. Next, there is the delimitation of the characteristic aspects of the National Health Agency (ANS), mainly in relation to the aforementioned list of procedures and events pertinent to it. Finally, the research exposes the recent understanding of the STJ on the problematic, besides the reflection on the maintenance of the contractual balance between the parties in face of the new promulgation of Law 14.454/22 and how the supplementary health sector may react in face of the modifications brought.