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The cost of jaw correction surgery must be paid by the health plan

The cost of jaw correction surgery must be paid by the health plan

In an injunction, Judge Jose Cicero Alves da Silva, of Maceió/AL, determined that a health plan allows and pays for a surgical procedure for a beneficiary with a mandibular diagnosis.

It is a business between the woman and the health plan she benefits from. The beneficiary told the court that she constantly suffers from headaches, joint pain and difficulty chewing, and therefore she needs surgery. It turned out that the plan refused to cover the procedure on the grounds that it was not on the ANS list.

The costs of mandibular correction surgery must be paid by the health plan.(Photo: Freepik)


Law judge José Cicero Alves da Silva decided that the health fund authorizes the necessary procedure for the author and pays for it in the manner requested by the doctors: “It is possible to conclude that the surgical intervention is of an emergency nature,” he said.

For the judge, the probability of the right is formed, since the plaintiff took strong evidence (medical reports), which testify to the disease that afflicted her.

“The patient’s right to health and life, and the inalienable and fundamental rights guaranteed by the main law, must be guaranteed from the perspective of the implementation of the basic principle of protecting human dignity, so that it is necessary that the health fund meets the medical request when it is proven by the health status of the plaintiff, as is the case in the case file.” .

Finally, the judge noted that STJ’s jurisprudence indicates the exemplary character of the list of mandatory actions for health plans stipulated by the Health Services Agency. It should be noted that this case is under judgment in the Nationality Court.

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Lawyer Bruno Federico Ramos de Araujo (Guedes & Ramos assistant lawyers) acted by the beneficiary.

Read the resolution.