Superior Court of Justice – Citizenship Court

For the third clbad of the Superior Court of Justice (STJ), plastic reconstructive operations aimed at removing excess skin from patients undergoing gastroplasty (bariatric surgery) should be funded by diets. ;Health Insurance.

That being so, the college upheld a judgment of the Federal District Court of Justice condemning a health insurance plan owner to cover the costs of the reconstructive surgery and to compensate the patient for the moral damages resulting from A refusal of undue coverage.

The decision reinforces the case law on the subject of private law bodies of the STJ. In addition, the fourth commission, when it ruled a similar process in 2016, understood that, if there was a medical indication regarding the need for a repair surgery (in case badyzed mammoplasty) in a stomach-reduction patient,

In the case of the third clbad, the operator appealed to STJ on the grounds that The procedures requested by the patient were not intended in the role of the National Supplementary Health Agency (NSA) and argued that the surgery would have an exclusively aesthetic connotation.

However, the Minister, Minister Villas Bôas Cueva, rejected the statement that the surgery would have only an aesthetic character. According to him, bariatric surgery – mandatory coverage in health care plans – has anatomical and morphological consequences that the system must also badume.

"There are situations in which plastic surgery is not just about rejuvenating or perfecting the beauty of the body, but primarily about repairing or rebuilding a part of the human body, or preventing health problems," did he declare.

The Minister cited judicial precedents that it was not enough that the plan operator pays for bariatric surgery, "

" Skin folds resulting in rapid weight loss must also be the subject of therapeutic attention, as they can lead to various health complications, such as recurrent candidiasis, bacterial infections due to: friction, odor and hernia, not qualifying, in the Hypothesis, air "

Villas Bôas Cueva pointed out that, if there is a medical indication to plastic surgery of character, it is necessary to remove excess epithelial tissue that is uniquely aesthetic, repairing or functional after bariatric surgery, it is not the responsibility of the operator to deny coverage because the treatment would not be adequate or would not of d

According to the Minister, restorative surgery is fundamental to the health of patients with morbid obesity, "even with the reduction of other complications and comorbidities, and not just an aesthetic procedure or rejuvenating. "

The Minister also recalled that although the ANS included only dermolipectomy in the role of post-bariatric surgery treatment procedures, health plans must restorative surgical procedures , "so as to carry out the entirety of the actions in recovery of the patient, in accordance with article 35-F of the law 9656/1998."

Damages moral [19659002] In unanimously rejecting the call of the operator, the group also confirmed the value of moral damages, set at R $ 10,000. The rapporteur recalled that, according to the jurisprudence of the STJ, the undue refusal of a medical care cover generates moral damage, because it aggravates the psychic sufferings of the user

According to the minister, the patient suffered losses with the postponement of the repair of plastic surgeries, which would have aggravated her state of mental health ", already weakened by the low self-esteem generated by the anatomical and morphological changes of the human body resulting of bariatric surgery, the recognition of moral damages ".