From the Editor
The Public Defender’s Office of Mato Grosso filed a public civil action, with an injunction request, at the Children and Youth Court of Campo Verde (134 km from Cuiabá) so that Unimed suspends all abusive co-participation charges to assist autistic children and adolescents with therapies multidisciplinary.
According to the action, the charge should also no longer appear on the December 2023 invoice.
If the Court accepts the request and the provider fails to comply, the Public Defender’s Office asks for a fine of R$10,000 for each insured affected.
The public defender who signed the action, Tânia Vizeu, also requested that, for collective moral damages, the health service provider pay the amount of R$100 thousand; and that contracts with families are not terminated and that autistic children and adolescents from Campo Verde, who contract with Unimed, receive comprehensive multidisciplinary treatment, such as Applied Behavior Analysis (ABA) and Ayres therapies, according to medical prescription and without limits in the number of sessions.
Tânia also requested that the provider be responsible for proving that clients do not have a legal right to the procedures, that the process has priority in processing, as the Child and Adolescent Statute (ECA) ensures priority for children and adolescents and that families are exempt from paying procedural costs.
The action was filed in favor of the more than 100 families that make up the Campo Verde Disabled Association (AME). But, collectively, it extends to all residents of the municipality who face the same problem with Unimed, Unimed Cuiabá and Unimed Rondonópolis, companies named as parties to the process.
“In total, 15 families came to us assuring us that since last year they have not been able to have or maintain continued treatment for their children. And an aggravating factor is that this care has a defined age range to have effective results in the cognitive development of these children and adolescents and what’s more, it is defined in Resolution 469/2921 of the National Health Agency (ANS), as being continuous and unlimited. of sessions. If there is no longer a limitation on the number of treatment sessions for autistic patients, it is clear that co-participation can no longer be charged for each session held”, he argued.
The defender recalled that the “excessive and illegal burden of contracts” forces families to give up the treatment prescribed by the doctor or to go into debt, when they cannot find alternatives to pay the minimum necessary. Limitation in treatment leads to worsening of the behavior and social life of children and adolescents, nervous crises due to the inability to deal with emotions, hypersensitivity to sounds, for example, and a drop in emotional health and quality of life. (With information from DPMT Advisory)