The treatment your doctor prescribed can be demanded in court

PRACTICE AREAS

The plan's denial or the SUS waiting list can be challenged. The law, court decisions and your doctor's report define what can be demanded. We also handle abusive increases, cancellation of the plan by the insurer, waiting periods, reimbursement and compensation for wrongful denial.

Surgeries and procedures

High-cost medication

Ongoing treatments

Claims against the SUS (public health system)

• Surgery denied, postponed or without coverage for materials

• Orthotics, prosthetics and special materials

• Bariatric and reconstructive surgery

• Procedures considered outside the ANS list

• Medication denied by the health plan

• Supply by the SUS, under the requirements set by the courts

• Cancer and rare disease medication

• Off-label medication prescribed by the doctor

• Autism (ASD) therapies and session limits

• Home care and home hospitalization

• Complete cancer treatment

• Physiotherapy, speech therapy and rehabilitation

• Surgeries with unreasonable waiting times

• Medication, supplies and special diets

• ICU beds and transfers

• Out-of-town treatment (TFD)

In health matters, time is part of the treatment. Our service is organized for that.

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You send the documents

We review the case and its urgency

You receive guidance and a proposal

On WhatsApp: the plan's denial or the SUS request number, the doctor's report with the prescription and justification, and the contract or member card. That is enough to get started.

We check the coverage, court decisions and the strength of the medical report, and assess whether an urgent request (injunction) is possible. If something is missing from the report, we tell you what to ask your doctor for.

We explain frankly the chances and the paths, in and out of court, and present a written fee proposal. The decision is always yours.

Founding attorney · Master's candidate in Law

The firm is led by attorney Sidnei Pedro Dias, with more than ten years of practice in medical and health law: requests for surgery, high-cost medication and treatments denied by health plans and the government.

OAB/GO 48.603 · OAB/DF 68.207 · OAB/SP 501.693

Headquartered in Anápolis-GO with fully digital service, SPD Advocacia works throughout Brazil, including in the higher courts (STJ and STF). The team follows every step, from the injunction request to enforcement of the decision.

Sidnei Pedro Dias Sociedade Individual de Advocacia · registered with OAB/GO under no. 3,123

Common examples, described in general terms. Each case depends on its own facts and documents.

Outside the ANS list

High-cost medication

A denial because the procedure is not on the ANS list does not always hold up. Law 14.454/2022 allows coverage beyond the list, and the STF, when ruling on ADI 7265, set criteria such as a prescription by the attending physician, no adequate alternative on the list, scientific evidence of effectiveness and registration with Anvisa. A well-supported medical report is decisive.

Expensive medication denied by the plan or not provided by the SUS can be sought in court, which has set specific requirements for these lawsuits, such as health registration, a well-grounded prescription and proof of need. Meeting them well from the start speeds up the case.

Limited autism (ASD) therapies

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Limiting therapy sessions prescribed for children with autism is a recurring denial, and the courts have recognized the right to treatment in the amount indicated by the professional caring for the patient, depending on each case.

Sharp increases, especially when moving into an older age bracket, when people need the plan most, can be reviewed in court when disproportionate or poorly justified, preserving the contract of those who have paid for a lifetime.

My case is urgent. How long does an injunction take?

It depends on the judge and the quality of the documents, and no lawyer can promise a timeframe or outcome. What depends on us: urgent cases are prepared and filed as a priority, with a well-grounded injunction request to allow a quick review.

What documents do I need?

The main ones: the doctor's report with the prescription and clinical justification, the plan's denial (or the request number, if they haven't even answered) and the contract or member card. For the SUS, the request numbers and proof of the wait. We explain what to ask your doctor if something is missing.

If I sue the plan, can it cancel my contract?

Going to court is not a legal reason to cancel the plan. For individual plans, Law 9.656/98 only allows unilateral termination for fraud or non-payment for more than 60 days, with prior notice; group plans have their own rules, which we also review.

How much does the lawsuit cost?

The initial review carries no obligation. If there is a case, the fee proposal comes in writing before any engagement, and the law guarantees free legal aid to those who cannot afford court costs without harming their livelihood, which we also assess with you.

Do you serve clients outside Goiás?

Yes, throughout Brazil. Service is digital, documents arrive via WhatsApp and lawsuits are processed electronically. The responsible attorney is admitted to the Bar in Goiás, the Federal District and São Paulo.

Send the denial and the medical report on WhatsApp. The team replies with an assessment of the case, an urgency review and a written proposal.

If you prefer, write to dias@spd.adv.br

Informational content, in line with OAB rules (Provision 205/2021). Each case needs its own analysis, and we do not promise results. Sidnei Pedro Dias Sociedade Individual de Advocacia · OAB/GO 3,123 · CNPJ 32.614.440/0001-25