Meu plano de saúde negou atendimento alegando doença preexistente

A negativa de cobertura sob a alegação de doença preexistente, é ilícita se não houve a exigência de exames médicos prévios à contratação.

A doença ou lesão, para que seja considerada preexistente, deve ter sido confirmada antes da celebração do contrato. Caso haja alguma dúvida, é lícito ao plano de saúde requerer avaliação médica do possível cliente para tentar confirmar a doença ou lesão.

Em resumo, a fim de que o plano de saúde se resguarde, é conveniente que se faça o exame admissional, sendo que, se não o fizer, deverá provar a má-fé do consumidor, algo extremamente difícil de se fazer, seja pela característica hipossuficiente desse, que não tem obrigação de conhecer critérios e termos médicos técnicos, seja pelo fato de que, se não conhecer sua doença preexistente, isso não poderá ser oposto pelo plano de saúde para evitar o custeio do tratamento.

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