Os planos de saúde são uma opção para quem busca um atendimento médico de qualidade, sem depender do sistema público de saúde. No entanto, muitas vezes os consumidores se deparam com situações em que os planos de saúde negam a cobertura de procedimentos, exames, tratamentos ou medicamentos que são essenciais para a sua saúde.

Essas negativas podem configurar práticas abusivas, que violam os direitos dos consumidores e colocam em risco a sua vida. Por isso, é importante que você saiba como se proteger dessas situações e como buscar a reparação dos danos causados pelos planos de saúde.

Por isso, hoje, o Blog M&R vai explicar quais são as principais práticas abusivas cometidas pelos planos de saúde e hospitais, como identificá-las e como agir diante delas. Vamos lá!

Quais são as principais práticas abusivas mais comuns dos planos de saúde e hospitais?

De acordo com o Código de Defesa do Consumidor, são consideradas práticas abusivas aquelas que coloquem o consumidor em desvantagem exagerada ou sejam incompatíveis com a boa-fé ou a equidade. No caso dos planos de saúde e hospitais, algumas das práticas abusivas mais comuns são:

– Negar a cobertura de procedimentos, exames, tratamentos ou medicamentos que estejam previstos no contrato ou que sejam indicados pelo médico assistente como necessários para o cuidado da enfermidade;

– Limitar o número de consultas, exames, terapias ou sessões de fisioterapia, psicologia ou fonoaudiologia;

– Impor carências excessivas ou não previstas em lei para a realização de determinados procedimentos;

– Aplicar reajustes abusivos nas mensalidades dos planos, sem justificativa ou critério objetivo;

– Rescindir unilateralmente o contrato do plano, sem motivo justo ou prévio aviso;

– Negar a liberação de cirurgias plásticas reparadoras, que tenham por objetivo restaurar a função ou a estética de alguma parte do corpo afetada por doença ou acidente;

– Negar a cobertura de home care, que consiste na internação domiciliar do paciente, quando houver indicação médica.

Como identificar práticas abusivas?

Para identificar as práticas abusivas dos planos de saúde e hospitais, é fundamental que você conheça os seus direitos como consumidor e como beneficiário do seu plano. Para isso, você deve:

– Ler atentamente o contrato do plano de saúde antes de assiná-lo, verificando quais são as coberturas, as exclusões, as carências, os reajustes e as penalidades previstas;

– Consultar o rol de procedimentos da Agência Nacional de Saúde Suplementar (ANS), que é uma lista mínima e obrigatória de procedimentos que devem ser cobertos pelos planos de saúde;

– Solicitar ao médico assistente um relatório detalhado sobre o seu diagnóstico, o tratamento indicado e a urgência do caso;

– Pedir ao plano de saúde uma justificativa por escrito sempre que houver uma negativa ou uma limitação de cobertura;

– Guardar todos os documentos que comprovem a relação contratual com o plano de saúde e a solicitação dos procedimentos.

O que fazer diante de uma prática abusiva?

Se você se sentir lesado(a) por alguma prática abusiva dos planos de saúde e hospitais, você pode tomar algumas medidas para defender os seus direitos e buscar a reparação dos danos. Veja quais são elas:

– Entrar em contato com o plano de saúde e tentar resolver o problema amigavelmente, apresentando os documentos que comprovem a sua necessidade e o seu direito à cobertura;

– Registrar uma reclamação na ANS, no Procon ou em algum órgão de defesa do consumidor da sua região, solicitando a intervenção dessas entidades na solução do conflito;

– Acionar o Poder Judiciário, por meio de uma ação judicial contra o plano de saúde, com o auxílio de um advogado especializado em Direito da Saúde. Nessa ação, você pode pedir uma liminar, que é uma decisão provisória e urgente, para garantir a cobertura do procedimento, além de uma indenização por danos morais e materiais, se for o caso.

Planos de saúde devem respeitar os direitos do consumidor

Os planos de saúde e hospitais devem respeitar os direitos dos consumidores e dos pacientes, oferecendo uma cobertura adequada e de qualidade para as suas necessidades de saúde. No entanto, muitas vezes eles cometem práticas abusivas, que prejudicam a saúde e a dignidade das pessoas.

Por isso, é importante que você saiba como se proteger dessas práticas, conhecendo os seus direitos, identificando as ilegalidades e buscando a reparação dos danos. Para isso, conte com o apoio do nosso time de advogados especializados em Direito da Saúde. Gostou do texto? Então compartilhe nas suas redes sociais e ajude outras pessoas a se informarem sobre esse assunto. E se você tiver alguma dúvida ou quiser saber mais sobre os seus direitos como consumidor de um plano de saúde, entre em contato com a Martins&Rodrigues, um escritório referência em respeito e confiança!

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    شما شگفت انگیز! با تشکر! که آنها کمک خواهند کرد، بنابراین
    در اینجا اتفاق می‌افتد.|
    شما حتما مطمئنا تخصص خود را در مقاله که می‌نویسید ببینید.

    بخش به حتی بیشتر نویسندگان پرشور مثل شما امیدوار است
    که {نمی‌ترسند} از گفتن اعتقاد خود
    هراسی ندارند. همیشه قلب خود را دنبال کنید.|
    عالی پست. منروبه‌رو می‌شوم|در
    حال گذراندن |
    عالی وبلاگ دارید اینجا..

    پیدا کردنش سخت است} عالی مانند شما این روزها.
    واقعا از امثال شما قدردانی می کنم!
    مراقب باش!!|
    این وب‌سایت توسط پسر عمویم پیشنهاد شد.

    در نظر بگیریم. من به شما می گویم،
    من قطعاآزارم عصبانیت در حالی که |نگرانی|مسائل} که آنها
    به وضوحدر مورد نگرانی هایی که فقط نمی دانند.
    شما توانستید به بالا ضربه بزنید و
    همچنین همه چیز را بدون داشتن عوارض
    جانبی مشخص کردید، مردم می‌توانند در سایت شما.|
    وبلاگ عالی! من آن را در حین مرور در یاهو نیوز پیدا کردم.
    آیا پیشنهاد در مورد نحوه قرار گرفتن در لیست
    یاهو نیوز دارید؟ مدتی است که تلاش می کنم اما به نظر می
    رسد هرگز به آنجا نرسیدم!
    با تشکر|
    عالی سایت. بسیاری مفید اطلاعات در اینجا.
    من آن را برای چند دوستان ارسال می‌کنم و هم‌چنین در خوشمزه به اشتراک می‌گذارند.
    و بدیهی، ممنونم عرق شما!|
    عالی انتشار، بسیار آموزنده.
    تفکر می کنم چرا برعکس متخصصان این بخش {نمی‌دانند} می‌فهمند.

    نوشتن خود را باید ادامه دهید.من مطمئن
    هستم}، شما پایگاه خوانندگان بسیار بزرگی دارید!|
    ضرب عالی ! وقتی سایت خود را اصلاح
    می‌کنید، می‌خواهم شاگردی کنم، چگونه می‌توانم برای وبلاگ سایت مشترک شوم؟ حساب aided روشن و شفاف ایده| آشنا بودم.

    عالی امتیاز در مجموع، شما فقط دریافت کردید یک
    نام تجاری جدید. چه چیزی ممکن است شما
    توصیه می‌کنید در مورد انتشار خود} روز پیش؟ آیا مثبت؟|
    آیا اشکالی ندارید که چند از مقالات شما را تا
    زمانی که اعتبار و منابع را به وبلاگ شما ارائه می‌دهم نقل
    کنم؟ وبسایت من در بسیار یکسان توقف شماست
    و کاربران من واقعا از برخی از اطلاعاتی که در اینجا {ارائه می‌دهید}.
    لطفاً به من اطلاع دهید اگر این بسیار خوب
    با شماست. با احترام!|
    با داشتن این همه محتوای نوشتاری آیا تا به حال با مسائل
    سرقت ادبی یا نقض حق چاپ مواجه شده اید؟ سایت من دارای محتوای بی نظیر زیادی است که من
    خودم یا خودم ایجاد} یا برون سپاری کرده ام، اما به نظر می رسد بسیاری از آن ها هستند.

    نمایش آن در سرتاسر وب بدون موافق من.

    آیا هیچ راه حل برای کمک به
    عالی {محصولات} از شما مرد. من آگاه باشید مطالب خود را
    قبل از و توی فقط بسیار عالی.
    من واقعا آنچه را که داریم گرفتم اینجا،
    مطمئنا دوست دارم تو بیان|گفتن} و بهترین
    راه به‌وسیله می‌گویی. می‌سازید آن را لذت‌بخش می‌کنید و به آن ادامه می‌دهید مواظب تا آن را باهوش نگه دارید} .
    من نمی‌توانم صبر کنم تا از شما بخوانم خیلی بیشتر.
    این است واقعا یک عالی سایت.|
    اگر کسی نیاز دارد با گرم‌ترین فناوری‌ها به‌روز
    شود بعد باید visit این سایت بروید و همه وقت به روز باشید.|
    من معجب بودم که آیا تا به حال {به این فکر می‌کنید که} ساختار blog خود را
    تغییر دهید؟ بسیار خوب نوشته شده است؛ من عاشق چیزی هستم که باید بگویی
    اما شاید بتوانید کمی بیشتر در مسیر محتوا قرار دهید تا مردم بتوانند بهتر
    با آن ارتباط برقرار کنند. فقط
    برای داشتن یک یا 2 تصاویر متن بسیار زیادی
    دارید. شاید بتوانید آن را بهتر از هم
    جدا کنید؟|
    خیلی به زودی این سایت در میان همه وبلاگ‌نویسی و سایت‌سازی بازدیدکنندگان مشهور خواهد شد.
    ، به دلیل اینکه پست است، خوب است}|
    اگر کسی آرزواست نظر متخصص درباره راه‌اندازی وبلاگ سپس مشاوره به او برای رفتن برای دیدن
    این صفحه، ادامه دهید عصبی کار.|
    اجناس عالی از شما مرد. من مطالب شما را قبلاً درک کرده ام و تو فقط بسیار عالی} عالی.
    من در واقع آنچه را که در اینجا به دست
    آورده‌اید، واقعاً، واقعاً آنچه را که می‌گویی} و
    نحوه بیان آن را دوست دارم. شما آن را سرگرم کننده می‌کنید و همچنان مواظب
    هستید تا آن را هوشمند نگه دارید.

    من نمیتونم صبر کنم تا خیلی بیشتر از شما بخونم.
    این در واقع یک برد فوق العاده استderful| فوق العاده} سایت.|
    ضرب عالی ! من می‌خواهمهمزمان با وب‌سایت خود را اصلاح می‌کنید، چگونه
    می‌توان برای یک وبلاگ وب
    سایت؟ حساب aided یک معامله قابل اجرا.
    من بودمآشنای} با این پخش شما ارائه
    روشن شفاف مفهوم|
    معمولا من در وبلاگ‌ها آموختم
    پست می‌کنم، هر چند می‌خواهم بگویم که
    این نوشته بسیار فشار نگاهی به و چنین انجام دهم!

    طعم نوشتن شما مرا متعجب کرده است.
    ممنونم، بسیار خوب مقاله.|
    این وب‌سایت توسط پسر عمویم} توصیه شد.
    من اکنون نه مثبت یا نه این انتشار نوشته شده است واقعا منظم نوشته شده است.
    مطمئن می‌شوم آن را نشانک‌گذاری می‌کنم و
    برمی‌گردم تا از مفید بیشتر مفید بیشتر.
    بابت پست ممنون. حتما برمی گردم.|
    با تشکر برای شما را تخصص
    داشتم، از بارگذاری مجدد سایت بسیاری از بارها قبل از من می‌توانستم آن را درست بارگیری کنم.
    می‌دانستم که آیا میزبانی وب شما خوب
    است؟ نه اینکه شکایت می‌کنم، اما زمان‌های بارگیری اغلب روی قرارگیری شما در
    Google تأثیر می‌گذارد و می‌تواند
    به کیفیت در صورت تبلیغات و بازاریابی با Adwords.

    به هر حال دارم این RSS را
    به ایمیل خود اضافه می‌کنم و می‌توانم به دنبال بسیار چیزهای دیگر جذاب شما باشم.

    محتوای | هیجان انگیز}. مطمئن شوید این را دوباره به زودی به روز کنید.|
    آنچه من نمی‌دانم این است که اگر حقیقت گفته شود چگونه هستید دیگر نیستید واقعا خیلی بیشتر خوب-پسندیده
    از شما ممکن است در حال حاضر.
    شما خیلی باهوشی. از قبل می‌دانید بنابراین به‌طور قابل ملاحظه‌ای ارتباط با این موضوع، من
    را انفرادی باور آن را از {تصور کنید} زوایای بسیار زیاد|تعدادی|بسیاری از} تعدادی.
    مانند مردان و زنان نه علاقه‌مند تا این یکی است کاری} برای انجام با گاگای دختر!

    خود شما چیزهای عالی است. همیشه مواظب!|
    عجب! بالاخره من یک وبلاگ دریافت کردم که از آنجا میتوانم
    واقعاً |در واقع|درست|واقعاً} دریافت مفید اطلاعات درباره مطالعه و دانش من.|
    وقتی کسی پست را می نویسد، تصویر یک کاربر را در
    ذهن خود
    سلام، آره این پست در واقع خیلی خوب است و من
    چیزهای زیادی از آن در مورد
    وبلاگ نویسی یاد گرفتم. با
    تشکر. برای من، از این لحظه من دارم این عظیم آموزنده
    پست را اینجا در خانه.|
    سلام، همه اینجا خوب پیش می‌رود و
    البته همه حقایق را به اشتراک می‌گذارند، این در
    واقع عالی، به نوشتن ادامه دهید.|
    A impressive! من همین الان این را برای یک
    دوست که بود یککوچکی تحقیق در مورد این.

    و برای من در واقع سفارش داد ناهار به این دلیل
    که برای او کشف کردم روده بر شدن از خنده.

    بنابراین {اجازه دهید} این را دوباره بنویسم ….

    متشکرم وعده غذایی!! اما بله، {تشکر} از اینکه مدتی زمان را
    صرف بحث و گفتگو در مورد} این
    مسئله در اینجا در وب سایت.|
    اوه این وبلاگ عالی من دوست دارم پست‌های شما را می‌خوانم|مطالعه می‌کنم.
    {بمانید|به کار {خوب|عالی} ادامه دهید!

    {می‌دانید|می‌فهمید|می‌دانید|می‌شناسید|از
    قبل می‌دانید}، {بسیاری|بسیاری
    از|خیلی‌ها} {مردم هستند|افراد هستند|افراد} {شکار|جستجو|نگاه می‌کنند} {در اطراف|دور می‌گردند} برای این {اطلاعات|اطلاعات}، {می‌توانید|می‌توانید}
    بسیار به آنها {کمک|کمک کنید}. |
    {سلام|هیا|هی|هی|روز بخیر|سلام|سلام|سلام|سلام|سلام}!
    من می دانم که این تا حدی خارج از موضوع است {با این حال،|با این وجود|اما|اما} فکر
    می کردم بپرسم. آیا علاقه مند به {تبادل|تجارت}
    پیوندها هستید یا ممکن است مهمان {نوشتن|نویسنده} یک
    وبلاگ {مقاله|پست} باشید یا بالعکس؟ {وب‌سایت|سایت|وبلاگ} من {می‌گذرد|بحث می‌کند|آدرس|پوشش می‌دهد}

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