The decision considered the conduct of the illegal society and highlighted the illegality of the refusal to repay a vital treatment
The Court of Justice of San Paolo sentenced last Thursday 8, a company of the health plan to be reimbursed R $ 496.6 thousand to a patient with chronic renal disease after suspending the refund of hemodialysis sessions. According to the defense, the benefit was interrupted without contractual justification.
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The decision, signed by judge Larissa Gaspar Tunala of the second civil court of Butantã, considered the conduct of the illegal society and highlighted the illegality of the refusal to repay a vital treatment for the survival of the actor.
According to the defense, the patient depends on the high -flow hemodiaphiltration procedure made five times a week and had received almost complete reimbursements since 2013. However, the payments have been reduced since November 2023 and was completely interrupted in May 2024, without contractual changes or in the prescribed treatment.
The company claimed to respect the contractual limits, but the topic was rejected by the magistrate, who also questioned the regularity of the service clinic. According to her, the contractual clause has no clear information on the coverage limits, which violate the basic rights of consumers and the patient should not be penalized for suspicions relating to the place that performs the procedures.
“If there are fraud, it is up to [empresa de plano de saúde] Analyzes with adequate care for individual relationships, not penalizing what has no correlation with the facts. At the limit, it is important to know if the author is treated and if the reimbursement values are consistent with what is practiced on the market at the same level of services, “said the judge.
In addition, the contract between the parties expressly provided for the free choice of service providers, without the obligation to use the accredited network. “There is an accredited network is an irrelevant lawyer, because the contract allows the free choice of the consumer,” he said.
“The judiciary’s decision will allow the beneficiary to promote their treatment in clinics that offer differentiated treatment, as has been performed before the entry of the action, also in a comfortable, sophisticated and welcoming environment, which enhances every human being, allowing the opportunity to improve the quality of life and all his family” Earth.
Source: Terra
Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.
