Tatiane Bagagí Faria
Lawyer at Marcos Martins Advogados
The São Paulo State Court of Justice has issued an injunction forcing a health insurance company to pay for treatment with specific medication for a patient who spent 20 days in the ICU of a hospital in the capital after being diagnosed with Covid-19.
In the case, the patient, after being discharged from hospital, was surprised to be charged R$20,000.00 (twenty thousand reais) by the hospital, due to the health plan’s refusal to pay for the medication used in the treatment of Covid-19, since the package leaflet did not state that the medication was indicated for the aforementioned illness, and therefore, according to the health plan, it was not obliged to pay for the treatment adopted.
The insured woman filed a lawsuit with a request for an injunction, which was granted by the Judge of the 2nd Civil Court of the Pinheiros Regional Court, in the capital of São Paulo, on the grounds that, although the drug is included in the ANS list, a fact that binds health plans to pay for it, in this specific case, the drug used must be interpreted as an integral part of the treatment needed to deal with the illness, and the health plan is obliged to cover and pay for it.
Considering that there is no consensus on the treatment of Covid-19, any medication used must be experimental or off-label, a fact which, according to case law, does not give health plans the right to deny coverage and funding to insured people.
The Marcos Martins law firm is attentive to new developments in case law, in order to provide adequate and effective advice to our clients.
