Post by account_disabled on Mar 12, 2024 0:31:40 GMT -5
Preventing health plan consumers from accessing more efficient treatment methods, as they are not included in the National Health Agency's list, constitutes abusiveness and disrespects the Consumer Protection Code.
reproduction
Health plan cannot exempt itself from providing medications based on an outdated list
Reproduction
This was the understanding of the Portugal Mobile Number List São Paulo Court of Justice, when condemning a company that provides health plans to pay for the medicines necessary to carry out adequate treatment for a woman suffering from atopic dermatitis.
The plaintiff in the lawsuit is a beneficiary of a health plan that refused to pay for her medications. She filed a lawsuit to have the company cover her treatment. In the first instance, the request was dismissed as unfounded.
In the appeal, the reporting judge, José Aparício Coelho Prado Neto, argued that the fact that the treatment recommended by the author's doctor was not included in the ANS procedure list does not justify its non-provision by the health plan.
"Advances in medicine are not always observed, with the necessary speed, to update the reports downloaded by the ANS which, it must be said, are merely exemplary, a failure that, evidently, cannot bring harm to the consumer, in this case, the author, as the defendant intends", stated the rapporteur.
Finally, for Prado Neto, the defendant's refusal to provide the medication compromises the very objective of the health plan contract, which is to protect the right to health; It also causes contractual imbalance and exaggerated disadvantage to the consumer, prohibited by the CDC. The author was represented by lawyer Carlos Roberto Pegoretti Júnior.
reproduction
Health plan cannot exempt itself from providing medications based on an outdated list
Reproduction
This was the understanding of the Portugal Mobile Number List São Paulo Court of Justice, when condemning a company that provides health plans to pay for the medicines necessary to carry out adequate treatment for a woman suffering from atopic dermatitis.
The plaintiff in the lawsuit is a beneficiary of a health plan that refused to pay for her medications. She filed a lawsuit to have the company cover her treatment. In the first instance, the request was dismissed as unfounded.
In the appeal, the reporting judge, José Aparício Coelho Prado Neto, argued that the fact that the treatment recommended by the author's doctor was not included in the ANS procedure list does not justify its non-provision by the health plan.
"Advances in medicine are not always observed, with the necessary speed, to update the reports downloaded by the ANS which, it must be said, are merely exemplary, a failure that, evidently, cannot bring harm to the consumer, in this case, the author, as the defendant intends", stated the rapporteur.
Finally, for Prado Neto, the defendant's refusal to provide the medication compromises the very objective of the health plan contract, which is to protect the right to health; It also causes contractual imbalance and exaggerated disadvantage to the consumer, prohibited by the CDC. The author was represented by lawyer Carlos Roberto Pegoretti Júnior.