RIGHT TO HEALTH AND AUTISM SPECTRUM DISORDER: ACCESS TO ADEQUATE TREATMENT AND LEGAL ACTION AGAINST HEALTH INSURANCE PLANS

Abstract

Autism Spectrum Disorder (ASD) requires multidisciplinary treatments that are essential for the development and quality of life of patients, but families face obstacles in obtaining coverage by health plans, leading to legal action. This study analyzes the implementation of the right to health of people with ASD within the scope of supplementary health plans, focusing on access to adequate treatments and court decisions that guarantee these rights. The methodology was based on a bibliographic and documentary review, covering legislation, doctrines, scientific articles, and case law. The results reveal that, although Law No. 12,764/2012 and RN 539/2022 of the ANS ensure rights, insurance companies often deny coverage, alleging that they are absent from the list of procedures. Court decisions, such as those of the STJ and TJSP, have been fundamental in guaranteeing prescribed therapies, including music therapy and methods such as ABA, reinforcing the primacy of health over contractual limitations. It is concluded that judicialization, although necessary, exposes flaws in regulation and monitoring, requiring greater transparency from operators, review of the ANS list and effective public policies. The implementation of these rights requires joint action by the State, the Judiciary and society to ensure dignified and timely treatment.