A (I)LEGALIDADE DA NEGATIVA DE COBERTURA DOS TRATAMENTOS APPLIED BEHAVIOR ANALYSIS (ABA) E DENVER PARA PESSOAS COM TRANSTORNO DO ESPECTRO AUTISTA (TEA) PELOS PLANOS DE SAÚDE NO BRASIL

Abstract

This undergraduate thesis aims to analyze the hermeneutic construction of the legality of health insurance companies’ refusal to cover Applied Behavior Analysis (ABA) and the Denver Model therapies for individuals with Autism Spectrum Disorder (ASD) in Brazil. Historically, health plan operators have recurrently denied such coverage, but a recent jurisprudential shift on the matter has led to a significant increase in related lawsuits. The adopted methodology consists of a critical analysis of legal norms (the Federal Constitution, the Consumer Defense Code, the Health Plans Law, and the Autism Law) and jurisprudence, with emphasis on Special Appeal (REsp) No. 2.043.003/SP. The analysis demonstrates that the current refusal to cover specialized therapies is abusive, since the law guarantees comprehensive healthcare for individuals with autism, and the Superior Court of Justice (STJ) has established the mandatory coverage of any method or technique prescribed by the attending physician. It is concluded, therefore, that the denial of coverage for ABA and Denver therapies by health plans is illegal, constituting a violation of fundamental rights and the dignity of individuals with ASD, and that judicial decisions have been essential to ensure the continuity and comprehensiveness of treatment.