O plano de saúde pode interromper tratamento?

Você já deve ter passado por isso ou conhece alguém que tenha passado.

Seu plano de saúde interrompeu seu tratamento.

O paciente está no meio de um tratamento psicoterápico quando o plano de saúde diz que não vai mais cobrir as sessões.

Essa interrupção compromete seriamente o tratamento e deixa o paciente inseguro e o profissional frustrado por não concluir o seu trabalho.

 Saiba que, é o médico ou o profissional habilitado quem estabelece a orientação terapêutica a ser dada ao usuário em busca da cura, e não o plano de saúde.

A interrupção do tratamento nesses casos se revela incompatível com a equidade e a boa-fé, “colocando o usuário em situação de desvantagem exagerada”. Porém, para não haver o esvaziamento do tratamento , “a quantidade que ultrapassar o número de sessões e poderá ser suportada tanto pela operadora quanto pelo usuário, em regime de coparticipação”.

A estipulação de coparticipação nessas situações se revela necessária, porquanto, por um lado, impede a concessão de consultas indiscriminadas ou o prolongamento em demasia de tratamentos e, por outro, restabelece o equilíbrio contratual (art. 51, § 2º, do CDC), visto que as sessões acima do limite mínimo estipulado pela ANS não foram consideradas no cálculo do fundo mútuo do plano, o que evita a onerosidade excessiva para ambas as partes.

Mas há decisões judiciais que entendem que a cobertura deve ser ilimitada, sem a cobrança em forma de coparticipação, portanto, há dois tipos de entendimentos judiciais.

Sendo assim, lembre-se: é abusiva a clausula contratual ou ato de plano de saúde que interrompa tratamento psicoterápico por esgotamento do número de sessões anuais asseguradas pela ANS.

Portanto, caso você esteja passando ou conheça alguém que esteja passando por situação como esta, algo que provavelmente provocará o insucesso do tratamento, não deixe de exercer o seu direito, mesmo que para isso seja necessária a via judicial.

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