Patients being treated for serious illnesses complain of sudden interruption of the contract by health companies
the federal deputy duarte jr. (PSB-MA), rapporteur of the Bill 7419 of 2006, which proposes changes to the Health Plans Law, informed on Monday (29.May.2023) that it will present an opinion to the Chamber on 7 June. The deputy said he will suggest a ban on termination of the contract unilaterally by health plans.
“The unilateral termination of the contract, which is already prohibited by the Consumer Protection Codein Article 51, establishes this unilateral termination as a null clause by operation of law, but it is important to enshrine, ratify in the new law on health plans, so that measures like this can no longer be carried out, they can be extinguished”, said Duarte.
The deputy participated in a public hearing at Alesp (Legislative Assembly of the State of São Paulo), which discussed abuses by operators and the supervisory role of the ANS (National Health Agency). User testimonies were collected about the abusive increase in monthly fees, the massive disqualification of clinics and hospitals and the unilateral cancellation, by plans, of contracts for patients undergoing treatment.
“These companies have an exemption in their income tax declaration. So, they are encouraged from a tax point of view and cannot just receive, have the bonus of receiving, and not assume their burden, when the consumer needs it most”, said the congressman.
In recent weeks, the São Paulo State Deputy, who proposed the public hearing, Andrea Werner (PSB), received at least 235 reports of unilateral cancellations of health insurance contracts, citing Unimed Nacional, Bradesco Saúde and Amil, from patients with treatments in progress. Among the discontinued therapies are those that treat Autism Spectrum Disorder or even cancer.
“So far, we have already sent to the Public Ministry more than 200 cases of unilateral cancellation of contracts for people undergoing treatment for cancer, autistic children, serious chronic diseases. All [cancelamentos] illegal”, stressed the deputy.
Werner proposes, as an emergency measure, a public civil action to reverse the abusive cancellations. “Many people can’t afford a lawyer to reverse this, but they also don’t have low enough income to go to the Public Defender’s Office. We hope that this becomes a public civil action and that the MP can reverse these cancellations so that these people can continue their treatments.”
In addition to proposing that the new law on health plans prohibit the unilateral termination of contracts for users undergoing treatment by operators, the deputy wants operators to start paying for the expenses of a companion in cases where the patient hospitalized in the ICU (Unit Intensive Care Unit) is under 18 years of age or has a disability.
“We also stated that if a clinic is to be disqualified, the new accredited one has to have the same quality, because they are disqualifying clinics that provide treatment for autistic people, or other children with disabilities, and replacing them with clinics that, sometimes, do not even have license from the Fire Department.”
Court decision
The lawyer, professor and specialist in Human Rights, Marcelo Válio, highlighted that there is a pacified understanding in the STJ (Superior Court of Justice) that health plans cannot terminate the contract of patients undergoing treatment.
“If we take into account only the legislation, the plans have the possibility of unilateral cancellation of collective plans. However, the STJ has already positioned itself in the following sense: those who are undergoing treatment, until medical discharge, cannot have their collective agreement terminated unilaterally by the agreement“, he spoke.
“Unfortunately, the National Health Agency, which is a specialized autarchy that should regulate and supervise health plans, sticks only to the legislation and completely forgets the reality that is the decision by the STJ”, said the lawyer.
Still according to Valio, the STJ did not consider only contractual rules and specific legislation, since the issue is the right to life. “We have to respect certain principles: the principle of the right to health, the principle of the right to comprehensive health care. And also one of the most important principles that we have, constitutionally speaking, which is the principle of human dignity“, he said.
plane suddenly cut
Therapeutic companion and psychology student Débora de Mello Rodrigues, mother of 7-year-old Lourenzo, diagnosed with autism and speech apraxia, reported that her son’s health plan was suddenly cut off by the operator.
“He was doing treatments with ABA therapy, speech therapy, occupational therapy. We have a huge range of professionals and all of that was cut overnight. We are in a very delicate moment, there is no justification. Perhaps he is too expensive a child for the plan.“, said.
According to Débora, initially, the company changed the clinic where Lourenzo was treated. “They sent a telegram saying that we were going to move to another clinic. We went to visit the clinic and it was totally without the right professionals.”
In May, the family received an email informing them that they would have a period of 1 month to transfer to another plan or leave.
treatment denial
Public official Sadrac Leite Silva, father of Leonardo, 8 years old, diagnosed with cancer, said that the health plan refused to give the child radiotherapy treatment and, shortly afterwards, informed the unilateral termination of the contract.
“We got desperate. What can we do now? Because his case is a tumor, which is already impairing his vision. He cannot wait months, he cannot interrupt the treatment. We were left with our hands tied with nothing to do.”
A resident of São Paulo, Silva said that the health operator even presented an alternative: taking his son for treatment in Bahia. “In an inhuman way, they gave us an alternative, which would have a plan available in the state of Bahia. We don’t have conditions, how am I going to have a treatment in the state of Bahia? I live here in São Paulo, it makes no sense. I was completely desperate“, he said.
The report of Brazil Agency sought the ANS, but did not receive a response until the publication of this text.
With information from Brazil Agency.
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