International Medical Assistance (Amil) was condemned for moral damages and will have to pay compensation of R$ 5 thousand for not having authorized the treatment of a patient who needed a breast lump surgery. In addition, the health plan will also have to return BRL 9,011.41 to the patient, who had the operation privately. The decision was taken by the Court of Justice of Ceará (TJCE) and was released on Monday, 10.
The patient had been diagnosed with a breast lump in 2017 and needed to undergo a surgical operation, as indicated by her doctor. The operation was requested for December of the same year, but the health plan did not authorize the treatment. Due to the urgency, the woman had to bear all hospital costs and medical expenses, as she could not wait for authorization.
The health plan claimed that the woman’s surgery request was made by an unaccredited doctor. “The health operator cannot demand that the patient, in order to have access to his right to health treatment, be conditioned to choose a professional accredited by the operator, especially when the law that regulates health plans does not make such a requirement”, countered the Court. of the 18th Civil Court of the District of Fortaleza, in the first instance of the judgment.
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According to the vote of the rapporteur of the judge Paulo Airton Albuquerque Filho, the delay in the authorization and in the availability of the materials and resources necessary for the execution of the surgery proved to be unfair and abusive. In all, the health plan was ordered to refund the amount spent by the patient, in the amount of BRL 9,011.41, and also to pay BRL 5,000 for moral damages with interest of 1% per month from the citation.
THE PEOPLE requested a position from Amil, which sent the following note: “Amil informs that it respects all contracts and that it fully complies with all court decisions, regulations and Brazilian laws”.
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