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O Supremo Tribunal Federal (STF) emitiu decisão recente que abre um precedente muito importante para os consumidores que possuem planos de saúde. Na decisão, a Quarta turma do STJ entendeu por determinar que uma operadora de plano de saúde reembolsasse integralmente as despesas feitas em hospital não credenciado, uma vez que, por ter assegurado ao consumidor a cobertura dos tratamentos médicos abarcados pelo contrato, a conduta da operadora configurou inadimplemento contratual.
O relator da decisão, o ministro Marco Buzzi, entendeu que a internação em hospital não integrante da rede credenciada não decorreu de mera conveniência do beneficiário, mas da impossibilidade técnica de continuidade do tratamento até então fornecido em hospital conveniado.
Nos termos do artigo 6º da Resolução Normativa 259/2011 da Agência Nacional de Saúde Suplementar (ANS), quando não houver prestador, integrante ou não da rede assistencial, que ofereça o serviço de urgência ou emergência demandado na região do beneficiário, a operadora deverá garantir o transporte do paciente e o custeio de seu tratamento em um prestador apto a realizar o devido atendimento.
Nesse cenário, cabia à operadora remover o paciente para uma unidade hospitalar, credenciada ou não, capaz de prestar o atendimento necessário e contratualmente previsto, arcando com os custos do transporte e da internação, o que não aconteceu, motivo pelo qual foi gerado o direito do consumidor de reaver os valores gastos.
Se você está ando por algum tipo de desentendimento com a sua operadora de saúde, não hesite em procurar um advogado de sua confiança para resolver a situação e lhe dar maiores explicações sobre os seus direitos enquanto consumidor.
CAROLINE REOLON SCARIOT – OAB/RS 122.057
PÂMELA LUÍSA HEINECK PARIZZI – OAB/RS 125.232
Fonte: https://www.jusbrasil.com.br/noticias/impossibilidade-de-tratamento-em-hospital-credenciado-justifica-reembolso-total-de-despesa-fora-da-rede/2008773708
Somos o jornal online do Vale do Taquari, RS. Jornalismo com responsabilidade e valorização das pessoas da região.
