Co-participation by the insured after 30 days of psychiatric hospitalization
A clause that establishes that patients hospitalized for more than 30 days for psychiatric reasons bear part of the medical expenses is not abusive. Based on this understanding, the minister of the Superior Court of Justice Isabel Gallotti accepted a special appeal from the insurance company Amil Assistência Médica Internacional and denied a man's request for compensation for moral damage and reimbursement of expenses. The minister's monocratic decision was based on the jurisprudence of the STJ. According to which the existence of a contractual clause that provides for the co-participation of the insured patient.In cases of psychiatric hospitalization for more Germany Phone Number than 30 days is not abusive, as long as the payment is limited to 50% of hospitalization costs, percentage admitted in normative resolution of the National Health Agency. In the claim for reimbursement and compensation, the patient claimed that he needed hospitalization for treatment of chemical dependency, but, despite having a corporate health plan, the operator refused to fully cover the hospitalization costs, demanding a 50% co-payment of the expenses from the 31st day.
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Non-existent abuse In the first and second instances, the Rio de Janeiro Court upheld the lawsuit's requests and ordered the operator to reimburse the patient for hospitalization expenses. The court also set compensation for moral damages of R$30,000, considering the contractual co-participation clause abusive. “This higher court, however, does not share the understanding adopted by the ordinary courts, as it has already decided that there is no abusiveness in the case, even more so due to the percentage of costs to be shared, which does not completely impede the use of services”, concluded the minister by denying claims for compensation and reimbursement.
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