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    Home»Science»If it doesn't provide the treatment, the plan must pay for a competing network, the judge decides
    Science

    If it doesn't provide the treatment, the plan must pay for a competing network, the judge decides

    Charlotte WhitmoreBy Charlotte WhitmoreMarch 23, 2024No Comments2 Mins Read
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    If it doesn't provide the treatment, the plan must pay for a competing network, the judge decides
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    The right to health

    The grace period for HMO coverage for urgent and emergency cases must be a maximum of 24 hours, according to Law No. 9,656/98 12 35-C.

    Health plan, doctor, hospital, medicine

    Judge orders operator to provide breast cancer treatment

    This was the basis adopted by Judge Josias Nunes Vidal, of the 18th Civil Court of Fortaleza, to convict a health plan operator for providing treatment to a woman diagnosed with breast cancer and to compensate her for moral damages.

    The judge also ordered a preliminary injunction of R$136,000 so that the company could pay for treatment in a competing private network if it did not have the necessary structure in its own network.

    In the process, the author stated that she was diagnosed with breast cancer with a 95% chance of spreading to other organs in her body. She said the health plan rejected her application on the grounds that she was in a waiting period for Medicaid coverage.

    In addition to the treatment recommended by the doctor, the author also requested that the worker be obligated to compensate for moral damages.

    Analyzing the case, the judge stated that the requirements of expectation of protection were present – the possibility of the existence of the right, the risk of harm or the risk of the beneficial outcome of the operation. He also pointed out that the right to health has a constitutional provision.

    “I consider that the good rights of the complainant and the risk of harm, because a delay in fulfilling such a request would pose a serious risk to the health of the patient, now the plaintiff. He noted that the initial need for the treatment requested by the plaintiff, a cancer patient, given the present situation of the complainant, is clear,” he noted. Failure to implement it at the present time may cause greater losses.

    See also  ANS cancels transfer, returns health plan wallet to Amil

    Therefore, the operator was ordered to provide treatment for the author's breast cancer under penalty of a daily fine of R$1,000 with a maximum of R$20,000.

    The author was represented by lawyers Frederico Cortez that it Erivelto Gonsalves.

    Click here to read the decision
    Process 0216439-23.2024.8.06.0001

    Charlotte Whitmore

    Charlotte Whitmore is a contributor at Mediarunsearch.co.uk, covering a broad range of topics including news, politics, business, technology, sport, entertainment, and lifestyle. She focuses on delivering clear, balanced reporting and practical information that helps readers stay informed about current events and emerging developments. Her work highlights stories that matter to everyday audiences, with an emphasis on accuracy, relevance, and accessible journalism that keeps readers connected to the issues shaping the UK and beyond.

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