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A empresa também deve custear todo o tratamento ao paciente. 5q6i1b Colatina em Ação – 04 de agosto de 2022
Operador de plano de saúde indenizará criança por recusar tratamento para autismo – Foto: Reprodução Uma criança, representada por sua genitora, pleiteou uma ação de indenização por dano moral, após ter seu pedido para tratamento de Transtorno de Espectro Autista (TEA) negado. De acordo com a mãe, a criança tinha inúmeras dificuldades de comunicação, e até os dois anos de idade, ainda não verbalizava nenhuma palavra. Os pais teriam buscado orientações médicas e o menor foi diagnosticado, em meados de 2019, com autismo infantil.
O TEA é uma patologia que compromete o desenvolvimento e a interação social da criança, podendo causar déficits na comunicação.
Médico neuropediatra 3h1b5h Por conseguinte, ainda em 2019, a criança teria iniciado tratamento fonoaudiológico, uma vez por semana, com profissional credenciada à cooperativa. Contudo, visando um melhor desenvolvimento de seu filho, a mãe narrou ter buscado acompanhamento psicológico para o mesmo, onde a orientaram a buscar por um médico neuropediatra.
Segundo os autos, a médica especialista em neuropediatria solicitou a intervenção por meio do método ABA, ou Análise Comportamental Aplicada, conhecida por auxiliar indivíduos diagnosticados com autismo a desenvolverem seus comportamentos sociais, tornarem-se independentes e garantir qualidade de vida.
No entanto, após um ano fazendo o tratamento com o método ABA, uma nova avaliação comportamental teria apontado prejuízos maiores em relação à fala do menino, o que a autora relatou ter incentivando-a a buscar consultas para novas orientações que visassem maior desenvolvimento na comunicação do requerente.
Procedente o pedido de indenização 5j3o1h Após três consultas com fonoaudiólogo e neuropediatra, teria sido recomendada, além da terapia amparada pela ciência ABA, intervenção com método PROMPT, uma abordagem utilizada para o estímulo dos aspectos cognitivos e linguísticos, três vezes por semana.
Todavia, ao dirigir-se à cooperativa a fim de obter a autorização para iniciar o novo tratamento, a autora expôs que a requerida negou a solicitação, alegando que o método PROMPT não faz parte do rol da ANS de procedimentos alcançados pela cobertura mínima obrigatória. A operadora do plano de saúde teria, ainda, orientado o paciente a retornar ao médico e procurar por outro tratamento.
O juiz da Vara Única de Santa Leopoldina julgou ser procedente o pedido de indenização, uma vez que o plano de saúde pode somente estabelecer quais doenças serão cobertas, não devendo definir a forma de tratamento dessas, e que, nestes casos, prevalece a prescrição médica. Desta forma, o magistrado condenou a ré a fornecer todo o tratamento indicado pela equipe médica e a pagar indenização por danos morais no valor de R$ 5 mil.
Fonte: TJES
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