Plano é condenado em R$ 20 mil após negar procedimento

Um senhor de 92 anos teve que acionar a justiça para conseguir realizar o implante de um marca-passo, embora fosse cliente do plano de saúde Bradesco Saúde desde 1984. Além da tutela de urgência que assegurou a realização do procedimento, o plano de saúde também foi condenado a indenizar o cliente em R$ 20 mil por danos morais.

O plano teria se recusado a autorizar o implante de marca passo bicameral definitivo, mesmo que solicitado conforme laudo médico, pois a cobertura do requerente não abrangeria a implantação de próteses.

A empresa alegou ainda que seria necessário adequar o plano do autor da ação aos moldes da Lei nº 9656/98, que dispõe sobre os planos e seguros privados de saúde.

Segundo o juiz da 3º Vara Cível de Vitória, Jaime Ferreira Abreu, no contrato firmado entre as partes, é vedado o implante de aparelhos estéticos ou protéticos de qualquer natureza, porém, o mesmo não acontece com órteses, categoria na qual se enquadraria o marca passo.

Da mesma forma, o magistrado afirma que contratos firmados antes da Lei nº 9656/98 não permitem qualquer tipo de vedação por parte dos planos, sendo, então, devida a realização do procedimento.

Quanto aos danos morais, o juiz afirma que o desgaste emocional sofrido pelo autor idoso, o colocou em risco de vida, desta forma, configurando muito mais que mero dissabor, justificando assim a condenação.

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