Healthcare coverage for autism spectrum disorder treatment in health plans in recent case law of the Court of Justice of the state of São Paulo Luciano Pereira de Souza, Emilia de Abreu Antonelli

Abstract

Background: Every day, more people are diagnosed with autism. Problem: Given the increase, questions arise: which therapies are covered by these beneficiaries and what is the position of the Court of Justice of the State of São Paulo regarding the judicialization of the issue. Objective: to determine the position of the Court of Justice of the State of São Paulo regarding the constitutional provisions and the regulation of supplementary health, regarding the limits of assistance coverage for beneficiaries diagnosed with Autism Spectrum Disorder. Methods: descriptive, qualitative research, based on the survey of collegiate judicial decisions and scientific articles, through bibliographic review and documentary research on the topic discussed. Results: the selected judgments demonstrated that the court under study has a tendency to grant therapies and methodologies according to medical prescription, based on Normative Resolution 539 of 2022 and summary no. 102 of the TJSP. However, the same court disagreed with regard to the coverage of certain therapeutic resources: hydrotherapy, equine therapy, music therapy, educational support and physical education. Conclusion: it can be seen from the results presented that the topic requires further study, since it is extremely necessary for both health insurance companies and beneficiaries to be aware of which therapies and methodologies have contractual coverage, which will prevent legal uncertainty.