Post by account_disabled on Mar 12, 2024 0:37:55 GMT -8
If the disease is covered, the health plan cannot limit your treatment, refusing to pay for it or restricting the number of sessions. This understanding was reached by judge Eduardo Calvert, from the 1st Civil Court of Mogi das Cruzes (SP), when deciding that a health plan operator cannot impose a limit on the number of treatment sessions for an autistic child.
reproduction
Reproduction Plan cannot limit the number of treatment sessions for autistic children
The author also intended for the plan to cover alternative treatment, called ABA Therapy, but the request was denied, based on technical information. It is stated in the records that the operator covers conventional treatment, but seeks to limit the number of sessions.
According to the judge, the Portugal Mobile Number List limitation is abusive, as it impacts the fulfillment of the very purpose of the contract concluded between the parties. “This is not the author’s choice to carry out the number of sessions, but a condition for the effectiveness of the prescribed treatment”, he stated.
Regarding the cost of alternative therapy, the judge highlighted that NAT-Jus, a technical body supporting the Judiciary for actions involving health issues, pointed out the lack of scientific evidence demonstrating the greater effectiveness of the proposed treatments in relation to those contained in the ANS list and offered by the defendant. A technical study requested by the National Council of Justice reached a similar conclusion.
“In current times of pandemic, in which several unconventional treatments are used by thousands of people in the hope of finding a cure for the disease that affects millions, the need to listen to those who have the knowledge has become increasingly pressing. specialized technician on the issue”, he added.
Still in the context of the pandemic, Calvert cited as an example the scientific studies that have demonstrated that supposed early treatments against Covid-19 are not effective and, therefore, should not be adopted, such as the use of chloroquine and ivermectin.
"Thus, this magistrate cannot close his eyes to the scientific studies compiled by technical bodies supporting the Judiciary, all of which indicate that there is no evidence that demonstrates that the treatment required by the author is more efficient than that offered by the defendant", said the judge.
Thus, he stated that imposing on the health plan the obligation to pay for alternative treatments of unproven effectiveness, while there are proven effective alternatives available, "shows itself to be arbitrary and goes against the necessary contractual balance".
reproduction
Reproduction Plan cannot limit the number of treatment sessions for autistic children
The author also intended for the plan to cover alternative treatment, called ABA Therapy, but the request was denied, based on technical information. It is stated in the records that the operator covers conventional treatment, but seeks to limit the number of sessions.
According to the judge, the Portugal Mobile Number List limitation is abusive, as it impacts the fulfillment of the very purpose of the contract concluded between the parties. “This is not the author’s choice to carry out the number of sessions, but a condition for the effectiveness of the prescribed treatment”, he stated.
Regarding the cost of alternative therapy, the judge highlighted that NAT-Jus, a technical body supporting the Judiciary for actions involving health issues, pointed out the lack of scientific evidence demonstrating the greater effectiveness of the proposed treatments in relation to those contained in the ANS list and offered by the defendant. A technical study requested by the National Council of Justice reached a similar conclusion.
“In current times of pandemic, in which several unconventional treatments are used by thousands of people in the hope of finding a cure for the disease that affects millions, the need to listen to those who have the knowledge has become increasingly pressing. specialized technician on the issue”, he added.
Still in the context of the pandemic, Calvert cited as an example the scientific studies that have demonstrated that supposed early treatments against Covid-19 are not effective and, therefore, should not be adopted, such as the use of chloroquine and ivermectin.
"Thus, this magistrate cannot close his eyes to the scientific studies compiled by technical bodies supporting the Judiciary, all of which indicate that there is no evidence that demonstrates that the treatment required by the author is more efficient than that offered by the defendant", said the judge.
Thus, he stated that imposing on the health plan the obligation to pay for alternative treatments of unproven effectiveness, while there are proven effective alternatives available, "shows itself to be arbitrary and goes against the necessary contractual balance".