Priscilla Folgosi Castanh
Lawyer at Marcos Martins Law Firm
The 3rd Panel of the STJ, in overturning a ruling by the TJ/RJ, established that it is the responsibility of the health plan to pay for the expenses of companions of elderly patients who are hospitalized, as determined by the ANS – National Supplementary Health Agency.
The case arose from the hospital’s filing of a lawsuit against the patient and the health plan, claiming payment of expenses for the companion of an elderly woman who remained hospitalized, since the health plan refused to cover these costs.
The lower court judge ordered the patient to pay the telephone costs, while the health plan was ordered to pay the costs of medicines and surgical materials With regard to the companion’s expenses, the decision determined that this would be the responsibility of the hospital itself.
The Rio de Janeiro Court of Justice upheld the dismissal of the request for payment of the companion’s expenses, on the grounds that this obligation is imposed on the hospital under the Elderly Statute.
Dissatisfied with the judgment handed down by the TJ/RJ, the hospital appealed to the STJ claiming that the obligation laid down in the Statute of the Elderly had been fully complied with, however the legal requirement does not imply that the service provided is free of charge, so that the companion’s expenses must be covered by the health insurance plan In the judgment of the special appeal, the reporting judge, Villas Bôas Cueva, stated that the responsibility for paying for the expenses of an elderly person’s companion lies with the health plan operator, in line with the resolution of the National Supplementary Health Agency – ANS Nevertheless, it reinforced the elderly person’s right to a companion, guaranteed by article 16 of the Statute of the Elderly, which is a guarantee of the right to health and the protection of the elderly guaranteed by the Federal Constitution In this way, the special appeal filed by the hospital was upheld in order to order the health insurance company to pay the costs of the elderly patient’s companion.
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