The alternate section of STJ( Supreme Court of Justice) It was decided Wednesday( 22) that health plan drivers who unilaterally terminate group contracts are obliged to maintain the bond of cases in sanitarium or cases witnessing treatment for critical ails.
The decision, which lower courts should follow in analogous proceedings, says drivers must ensure treatment continues until discharge from the sanitarium.They have anatomized cases of a woman witnessing treatment bone cancer A minor with a habitual complaint.
They both went to court after the contract was suspended by Bradesco Saúde and were suitable to continue the content. The driver also appealed to the STJ, which has now formalized the understanding. sought, Bradsko Side stated that it “ does not note on matters brought to court. ”The Rapporteur of the case, Minister Luis Philippe Salomao, noted that the law formerly prohibits plan drivers health Under no circumstances should individualities terminate the contract while the stoner is in the sanitarium, and state that the understanding should extend to group plans.
“ Heirs can not be barred when they’re entering treatment for a serious illness or witnessing medical treatment that threatens their livelihood, ” he said.
The thesis defended by the Rapporteur was that “ the driver, indeed after the regular exercise of the right to unilateral termination of the collaborative plan, must insure the durability of the specified backing care to the stoner in the sanitarium or in the full medical treatment which assures him of his survival or physical safety until discharge factual, handed that the deliverer bears the full quantum due.
In a recent decision, dated June 8, issued STJ Health plan operators have been released To pay for actions not included in your list of coverage ANS (National Agency for Complementary Health).
With the decision, for the benefit of companies, it was come to understand that the role of the ANS is taxation. It is not typical.
At that time, the court also understood that the operator was not obligated to pay for an action if there was a similar option in the ANS menu. If there is no therapeutic alternative, treatment indicated by the responsible health professional may be covered, on an exceptional basis. required people can express their concerns with the federal council of medicine.
The reality shows that today we live longer, but a good part of our life is spent in bad shape and with chronic, irreversible diseases.
Coping with this rather new situation is the obligation not only of the medical staff but of every single human being. The physician has to act in a transparent manner, explain everything he is doing, and keep in close contact with the patient’s family.