No intuito de ser reembolsado do valor pago na aquisi\u00e7\u00e3o de endopr\u00f3tese, um paciente acionou a Justi\u00e7a Federal contra uma operadora de plano de sa\u00fade ap\u00f3s o requerente ter o fornecimento do material recusado.<\/p>\n\n\n\n
A operadora do plano justificou a recusa afirmando que o contrato n\u00e3o prev\u00ea a cobertura da pr\u00f3tese, n\u00e3o podendo, dessa forma, a empresa arcar com equipamento n\u00e3o previsto no instrumento contratual.<\/p>\n\n\n\n
Para a 6\u00aa Turma do TRF1, a cl\u00e1usula que restringe o custeio de pr\u00f3tese ou \u00f3rtese \u00e9 abusiva, tendo em vista que os equipamentos s\u00e3o indispens\u00e1veis para o \u00eaxito do procedimento m\u00e9dico ou cir\u00fargico coberto pelo plano de sa\u00fade.<\/p>\n\n\n\n
\u201cSob a \u00f3tica dos princ\u00edpios gerais dos contratos, a tese defensiva afronta a pr\u00f3pria l\u00f3gica do direito por ser inadmiss\u00edvel que operadoras de plano de sa\u00fade, instadas a custearem uma angioplastia, invoquem cl\u00e1usula restritiva ao fornecimento de materiais e equipamentos para justificarem a negativa de utiliza\u00e7\u00e3o de dispositivo imprescind\u00edvel para o sucesso do procedimento coberto pelo plano de sa\u00fade\u201d, ressaltou a ju\u00edza federal S\u00f4nia Diniz Viana, relatora em regime de aux\u00edlio de julgamento a dist\u00e2ncia.<\/p>\n\n\n\n
Nesses termos, o Colegiado reconheceu a nulidade da cl\u00e1usula, determinando o ressarcimento dos valores utilizados pelo autor na aquisi\u00e7\u00e3o da endopr\u00f3tese.<\/p>\n\n\n\n
Processo: 0004608-77.2004.4.01.3802<\/p>\n\n\n\n
TRF1 05.10.2020<\/p>\n","protected":false},"excerpt":{"rendered":"
No intuito de ser reembolsado do valor pago na aquisi\u00e7\u00e3o de endopr\u00f3tese, um paciente acionou…<\/p>\n","protected":false},"author":1,"featured_media":509,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","jetpack_publicize_message":"","jetpack_is_tweetstorm":false,"jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false}}},"categories":[11,28],"tags":[477,473,476,474,475,406],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=1880%2C1253&ssl=1","featured_image_urls":{"full":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=1880%2C1253&ssl=1",1880,1253,false],"thumbnail":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?resize=150%2C150&ssl=1",150,150,true],"medium":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=300%2C200&ssl=1",300,200,true],"medium_large":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=640%2C427&ssl=1",640,427,true],"large":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=640%2C426&ssl=1",640,426,true],"1536x1536":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=1536%2C1024&ssl=1",1536,1024,true],"2048x2048":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=1880%2C1253&ssl=1",1880,1253,true],"covernews-slider-full":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?resize=1077%2C715&ssl=1",1077,715,true],"covernews-slider-center":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?resize=522%2C500&ssl=1",522,500,true],"covernews-featured":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?fit=1024%2C682&ssl=1",1024,682,true],"covernews-medium":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?resize=540%2C285&ssl=1",540,285,true],"covernews-medium-square":["https:\/\/i0.wp.com\/blog.bfsadvocacia.com.br\/wp-content\/uploads\/2020\/10\/medical-appointment-doctor-healthcare-40568.jpeg?resize=375%2C250&ssl=1",375,250,true]},"author_info":{"display_name":"bfsadvocacia","author_link":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/author\/bfsadvocacia\/"},"category_info":"advogado sp<\/a> atualidades jur\u00eddicas<\/a>","tag_info":"atualidades jur\u00eddicas","comment_count":"0","amp_enabled":true,"_links":{"self":[{"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/posts\/508"}],"collection":[{"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/comments?post=508"}],"version-history":[{"count":1,"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/posts\/508\/revisions"}],"predecessor-version":[{"id":510,"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/posts\/508\/revisions\/510"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/media\/509"}],"wp:attachment":[{"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/media?parent=508"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/categories?post=508"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.bfsadvocacia.com.br\/index.php\/wp-json\/wp\/v2\/tags?post=508"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}