posted on 9/14/2021 4:40 PM
The Public Ministry of Minas Gerais (MPMG), through Procon, fined over R$ 10.7 million a health plan operator against a client. The company can still appeal the administrative decision.
According to the MPMG, Amil Assistência Médica Internacional SA refused to provide emergency care to a patient who had a heart attack. Thus, she could not be transferred to the Intensive Care Unit (ICU) and could not access the necessary medical and surgical procedures.
“Although Amil maintains, in its defense, that the beneficiary of the health plan was within the grace period, Procon-MG considered that the supplier violated the Consumer Protection Code (CDC), especially in relation to the maximum period of 24-hour grace period established to cover urgent and emergency cases”, explains the MPMG.
The health plan argued that the client was aware of the contractual terms, but Procon-MG highlighted that the contracting of the service does not involve an agreement in which the parties’ wishes are freely expressed, especially considering the lack of possibility of discussion regarding the drafting the contract. In fact, the rules are set unilaterally.
“As for the alleged care provided to the patient in the first 12 hours, the Procon-MG cited a summary of the Superior Court of Justice (STJ), according to which it is an abusive contractual clause of a health plan that limits the insured’s hospital stay”, details the agency. “During the administrative process, Amil refused to sign an agreement with Procon-MG.
The percentage of 90% of the value of the fine must be paid to the State Fund for Consumer Protection and Defense”, says the Public Ministry.
Sought out by the report, Amil spoke in a statement: “Amil informs that it is in contact with the Public Ministry-MG for clarification and that the beneficiary had her initial emergency care covered in an outpatient basis, as provided for by law and in a resolution of the National Supplementary Health Agency (ANS).”