Consumer News

health plan is doomed to create embarrassments for rugged child surgery

05/10/2016

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The 1st TJ's Civil Chamber confirmed the health plan obligation to indemnify the family of a child for the delay in the approval of surgical treatment urgency needed to prevent irreversible damage to the muscle and bone structure of the face of the little patient. traffic accident victims in 2010, the boy had head trauma and extensive facial and after several surgeries and complications, needed specialized treatment for reconstruction of the face.

The urgency of the procedure, since the boy is in the growth phase and could have more problems, the family funded expert in São Paulo. He therefore asked that the plan would cover the cost of the anesthesiologist and hospitalization, which was denied on the grounds that hospitals where professional chosen by the family worked were expensive and not accredited to Unimed Florianopolis.

However, the judge Raulino Jacob Brüning, rapporteur of the matter, noted that the plan hired by the family is nationwide and provides coverage of expenses for hospital stay and anesthesiologist requested by the child's parents. Furthermore, the web site of an institution appointed to perform the surgery is contracted by Unimed Paulistana.

"Now clear that the consumer Firming health plan contract with national coverage, see that the hospital in which must perform medical procedure has an agreement with Unimed, coupled with the fact the contractual clause be dubious, it means that your plan covers the costs incurred in the aforementioned nosocômio "mused the magistrate. The decision confirmed an injunction was determined to cover the surgical procedure and the payment of moral damages of R$ 50,000 to the author.

Source: TJSC

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