Plano deve custear tratamento de criança com síndrome de Asperger – Jornal Pequeno – MARANHÃO Hoje- Notícias, Esportes, Jogos ao vivo e mais

Admin 104 Comments

(Foto: Divulgação)

Decisão unânime da 2ª Câmara Cível do Tribunal de Justiça do Maranhão manteve sentença da 9ª Vara Cível de São Luís, para determinar que a Geap Autogestão em Saúde autorize e custeie integralmente o tratamento de criança, representada no processo por seu pai e sua mãe, em procedimento terapêutico com equipe multidisciplinar, com profissionais especialistas no tratamento de criança diagnosticada com transtorno do espectro autista, conforme relatórios médicos, de forma ininterrupta e contínua em sua rede credenciada. O plano de saúde também foi condenado a pagar R$ 10 mil, em indenização por danos morais. Ainda cabe recurso da decisão.

De acordo com o entendimento da sentença de 1º grau e da decisão do órgão do Tribunal, na hipótese de não haver profissionais habilitados, o plano deve efetuar o ressarcimento integral, no prazo de 30 dias, dos valores pagos de procedimentos que o plano não autorizar ou não possuir credenciados.

O plano de saúde alegou não obrigatoriedade de custeio de tratamento pelo método ABA, que considera altamente dispendioso, não coberto pelo plano de saúde e sem previsão no rol da ANS.

Também afirmou que a parte autora da ação na Justiça de 1º grau não contratou a extensão de qualquer tratamento e que, embora garanta a assistência de terapeuta ocupacional e fonoaudiólogo, não está obrigado a fornecer quaisquer outras subespecialidades elencadas para tratamento de autismo, baseado nos métodos ABA, Teacch, Prompt, Denver, integração sensorial e demais terapias, conforme rol de cobertura obrigatória da ANS.

VOTO

O relator das apelações do plano e de representantes da criança, desembargador Guerreiro Júnior, fundamentou seu voto com base em recente resolução normativa, a RN nº 539/2022, em que a Diretoria Colegiada da Agência Nacional de Saúde Suplementar (ANS) ampliou as regras de cobertura assistencial para usuários de planos de saúde com transtornos globais do desenvolvimento, entre os quais está incluída a síndrome de Asperger, um estado do espectro autista.

O desembargador também citou entendimentos do Superior Tribunal de Justiça. Segundo Guerreiro Júnior, o STJ considera abusiva a cláusula contratual que exclui tratamento prescrito para garantir a saúde ou a vida do beneficiário, uma vez que a operadora de plano de saúde pode estabelecer as doenças que terão cobertura, mas não o tipo de terapêutica indicada por profissional habilitado na busca da cura.

Na sequência, disse que o STJ tem reconhecido a impossibilidade de limitação das quantidades de sessões de terapia destinada ao tratamento de portadores do espectro autista e, em decisão recente, assegurou o tratamento baseado no método ABA para criança ou adolescente com menos de 18 anos portador de transtorno do espectro autista.

Também baseado em precedentes do STJ, acrescentou que a recusa indevida ou injustificada pela operadora em autorizar a cobertura financeira de tratamento ou exame médico a que esteja legal ou contratualmente obrigada, gera direito de reparação a título de dano moral, em razão de a medida agravar a situação física e psicológica do beneficiário.

Entendeu que o valor de R$ 10 mil atende aos parâmetros de razoabilidade e proporcionalidade, considerando sua dupla função – compensatória e pedagógica –, o porte econômico e conduta da empresa.

A desembargadora Nelma Sarney e o desembargador Jamil Gedeon, convocado para compor quórum, também negaram provimento ao apelo da operadora de saúde e deram provimento ao apelo da mãe e do pai da criança, de acordo com o parecer do Ministério Público do Estado.

Admin

More Posts

104 Comments

  12. chile football team offers new Australian users an exciting opportunity to kickstart their gaming journey with a $100 sign-up bonus. By registering a new account, players can instantly claim this generous bonus to explore a wide range of casino games, including slots, table games, and live dealer options. The platform ensures a safe, fair, and secure gaming environment, making it easy for newcomers to enjoy their first experience while maximizing their potential winnings right from the start.

  23. Hi there, just became alert to your blog through Google, and found that it is really informative. I am going to watch out for brussels. I will appreciate if you continue this in future. Many people will be benefited from your writing. Cheers!

  24. For the reason that the admin of this site is working, no question very rapidly it will be well-known, due to its quality contents.

  25. As the admin of this website is working, no doubt very rapidly it will be well-known, due to its feature contents.

  27. As the admin of this web page is working, no hesitation very soon it will be famous, due to its feature contents.

  28. Fantastic website. Lots of helpful info here. I’m sending it to a few friends ans additionally sharing in delicious. And of course, thank you in your sweat!

  29. Magnificent site. Plenty of useful info here. I am sending it to a few buddies ans additionally sharing in delicious. And naturally, thanks to your sweat!

  35. I am no longer certain where you are getting your info, but great topic. I must spend a while finding out more or understanding more. Thanks for great info I used to be searching for this information for my mission.

  36. Hi! I’ve been following your weblog for some time now and finally got the courage to go ahead and give you a shout out from New Caney Tx! Just wanted to mention keep up the fantastic job!

  37. Hey there! I’ve been reading your site for some time now and finally got the bravery to go ahead and give you a shout out from Huffman Tx! Just wanted to say keep up the excellent work!

  38. Hi there, I read your new stuff on a regular basis. Your writing style is witty, keep doing what you’re doing!

  45. Howdy! I simply wish to give you a big thumbs up for your excellent info you have got here on this post. I am coming back to your site for more soon.

  46. A fascinating discussion is definitely worth comment. I do believe that you should write more on this subject matter, it might not be a taboo matter but typically people don’t talk about such topics. To the next! Best wishes!!

  47. A fascinating discussion is worth comment. I think that you ought to write more on this subject, it might not be a taboo subject but typically people don’t talk about such subjects. To the next! Cheers!!

  48. A fascinating discussion is definitely worth comment. I think that you ought to write more about this subject, it may not be a taboo subject but usually people do not speak about such issues. To the next! Cheers!!

  49. A fascinating discussion is definitely worth comment. I think that you need to publish more about this topic, it may not be a taboo matter but usually people don’t discuss such issues. To the next! All the best!!

  53. Hi there, I read your blog like every week. Your humoristic style is awesome, keep doing what you’re doing!

  56. Hello, I check your blogs daily. Your story-telling style is witty, keep up the good work!

  57. Hi there, I check your new stuff on a regular basis. Your humoristic style is witty, keep it up!

  60. An interesting discussion is definitely worth comment. I do believe that you ought to write more about this topic, it might not be a taboo matter but typically folks don’t discuss these topics. To the next! Cheers!!

  61. An interesting discussion is definitely worth comment. There’s no doubt that that you should write more about this subject, it may not be a taboo subject but typically people don’t speak about such subjects. To the next! Many thanks!!

  62. A motivating discussion is definitely worth comment. I believe that you ought to publish more on this issue, it might not be a taboo matter but generally people don’t speak about such issues. To the next! Many thanks!!

  63. An interesting discussion is definitely worth comment. I believe that you ought to write more on this subject, it might not be a taboo subject but usually people do not talk about such topics. To the next! All the best!!

  64. A motivating discussion is definitely worth comment. I think that you need to publish more on this subject matter, it may not be a taboo subject but usually people do not speak about such subjects. To the next! Best wishes!!

  65. An interesting discussion is definitely worth comment. I think that you should write more about this topic, it may not be a taboo subject but generally people do not discuss these topics. To the next! Many thanks!!

  66. An interesting discussion is worth comment. I believe that you should write more on this subject, it may not be a taboo matter but generally people do not talk about such subjects. To the next! Cheers!!

  67. An intriguing discussion is definitely worth comment. I do think that you ought to write more about this issue, it might not be a taboo subject but usually people do not speak about these topics. To the next! Best wishes!!

  68. My brother recommended I might like this web site. He was totally right. This post actually made my day. You can not imagine just how much time I had spent for this information! Thanks!

  69. Very nice post. I just stumbled upon your weblog and wished to say that I have truly enjoyed browsing your blog posts. After all I’ll be subscribing to your feed and I hope you write again soon!

  70. It’s actually a cool and helpful piece of information. I am glad that you just shared this useful information with us. Please keep us informed like this. Thanks for sharing.

  71. Do you have a spam problem on this site; I also am a blogger, and I was wanting to know your situation; many of us have created some nice procedures and we are looking to swap methods with other folks, be sure to shoot me an e-mail if interested.

  72. What’s up to all, because I am truly eager of reading this blog’s post to be updated on a regular basis. It carries good data.

  74. It’s enormous that you are getting ideas from this piece of writing as well as from our argument made here.

  75. Greetings! Very useful advice within this post! It is the little changes that will make the most important changes. Thanks a lot for sharing!

  76. An outstanding share! I’ve just forwarded this onto a friend who has been doing a little research on this. And he in fact ordered me breakfast because I found it for him… lol. So let me reword this…. Thanks for the meal!! But yeah, thanx for spending some time to talk about this subject here on your internet site.

  77. I think this is among the most important information for me. And i’m glad reading your article. But want to remark on some general things, The website style is perfect, the articles is really great : D. Good job, cheers

  78. Slotica to dynamiczne kasyno w internecie, które zdobyło uznanie graczy w Polsce oraz poza jej granicami. Dzięki swoim unikalnym zaletom jest doskonałym wyborem zarówno dla początkujących, jak i doświadczonych entuzjastów gier hazardowych. Jednym z największych atutów platformy jest pełna obsługa w języku polskim, co ułatwia grę zarówno osobom z Polski, jak i Polakom mieszkającym w Niemczech czy Holandii.Jednym z wyróżników kasyna jest brak konieczności weryfikacji konta, co umożliwia natychmiastowe rozpoczęcie gry. Ekspresowe wypłaty wygranych oraz obsługa popularnych metod płatności, takich jak Revolut, czynią korzystanie z platformy wyjątkowo wygodnym. Co więcej, kasyno akceptuje płatności w polskiej walucie, oferując stawki zaczynające się już od 1 grosza – dzięki temu każdy gracz znajdzie tu coś dla siebie, niezależnie od budżetu.

  79. It’s great that you are getting ideas from this post as well as from our argument made at this place.

  80. This is very attention-grabbing, You are a very skilled blogger. I have joined your rss feed and look forward to searching for extra of your fantastic post. Additionally, I have shared your web site in my social networks

  84. My partner and I stumbled over here from a different web page and thought I might check things out. I like what I see so now i’m following you. Look forward to looking at your web page for a second time.

  85. I love what you guys are up too. This sort of clever work and reporting! Keep up the very good works guys I’ve added you guys to blogroll.

  88. Admiring the persistence you put into your blog and in depth information you provide. It’s great to come across a blog every once in a while that isn’t the same outdated rehashed information. Wonderful read! I’ve saved your site and I’m including your RSS feeds to my Google account.

  89. Since the admin of this site is working, no doubt very rapidly it will be renowned, due to its quality contents.

  90. I every time used to read piece of writing in news papers but now as I am a user of web so from now I am using net for articles, thanks to web.

  92. Hi there, just became alert to your blog through Google, and found that it’s truly informative. I am gonna watch out for brussels. I will be grateful if you continue this in future. A lot of people will be benefited from your writing. Cheers!

  93. fantastic issues altogether, you simply received a new reader. What might you suggest about your put up that you simply made some days ago? Any sure?

  94. As the admin of this website is working, no uncertainty very quickly it will be famous, due to its feature contents.

  96. Very good article! We are linking to this great post on our website. Keep up the good writing.

  97. I think the admin of this site is genuinely working hard in favor of his web page, as here every stuff is quality based data.

  99. This website was… how do I say it? Relevant!! Finally I’ve found something that helped me. Thank you!

  100. Slottica Casino to propozycja dla graczy szukających nowoczesnej platformy do gry online i wygodnego dostępu do szerokiej oferty rozrywki. Serwis wyróżnia się intuicyjnym interfejsem, sprawną obsługą płatności oraz atrakcyjnym wyborem gier dopasowanych do różnych preferencji. Na szczególną uwagę zasługują wysokie standardy bezpieczeństwa, w tym szyfrowanie danych i rozwiązania chroniące prywatność użytkowników na każdym etapie korzystania z platformy. Dzięki temu gracze mogą skupić się na zabawie, mając pewność, że ich dane osobowe i finansowe są odpowiednio zabezpieczone. To jeden z ciekawszych wyborów dla osób zastanawiających się, gdzie grać online w bezpieczny i komfortowy sposób.

  101. I’m extremely inspired along with your writing skills and also with the format to your weblog. Is that this a paid subject matter or did you customize it yourself? Either way stay up the nice high quality writing, it is uncommon to see a nice weblog like this one nowadays..

  102. If you would like to increase your knowledge simply keep visiting this web site and be updated with the newest news update posted here.

  103. Oh my goodness! Amazing article dude! Many thanks, However I am experiencing issues with your RSS. I don’t understand the reason why I cannot join it. Is there anybody else having identical RSS issues? Anyone that knows the solution can you kindly respond? Thanx!!

  104. Vavada to znane kasyno online, które działa również w Polsce. Strona przyciąga graczy szeroką ofertą gier, przejrzystymi warunkami i obsługą w PLN (zł). Bonus powitalny oraz intuicyjna obsługa sprawiają, że platforma zdobyła popularność wśród polskich użytkowników.

Deixe um comentário

O seu endereço de e-mail não será publicado. Campos obrigatórios são marcados com *