Health plan claims ‘damage’ and cancels care for autistic children; mothers go to court | More health

At least 20 mothers of children with Autism Spectrum Disorder (ASD)who live in Baixada Santista, were surprised by the cancellation unilateral of your children’s Amil health plan. According to the g1 found, this Wednesday (8), the benefits administrator Qualicorp claimed that the beneficiaries’ contracts with the operator come “generating accumulated losses” (look above).

Mothers interviewed by the reporting team explained that health plans are of the collective by membership. That is, Qualicorp acts as an intermediary and manages contracts with coverage offered by the operator Amil, which receives payment.

In a note, Qualicorp stated that the decision to cancel the plan did not come from her. According to the company, the operator Amil exercised a right provided for in the contract and regulated by the National Supplementary Health Agency (ANS) (read the full position at the end of the report).

Little Bernardo Barbosa, aged seven, lives in Praia Grande (SP). He has been using the health plan for almost three years for multidisciplinary treatment, including psychotherapy and psychopedagogy. Last Tuesday night (30), his mother received the email about the interruption of the contract in June 1.

“They gave us 30 days to just get by, and everything is ok”, said housewife Marcelle Barbosa, who is 36 years old, to g1.

Marcelle told g1 that since last year she has heard about the possible interruption in the membership plan. Now that the decision is official, she sought out a lawyer and went to court so that her son’s development is not harmed.

“My son needs therapy, he does ABA [Análise do Comportamento Aplicada] 19 hours a week, four times a week, and that’s okay, he’s not going to die because of it. But it will cause an extraordinary delay in his life if he doesn’t take the therapies.”

Just like Marcelle, Praia Grande resident Dayah Castro, 39 years old, was surprised by the email from Qualicorp last Tuesday. Salomão Castro Silva, 11 years old, is also on the spectrum and undergoes psychotherapy, speech therapy and occupational therapy daily to maintain his learning.

“This treatment cannot be stopped overnight. An autistic person becomes dysregulated, he lives based on routine. And how does his routine change from one day to the next?” asked the health insurance broker.

“We know that, under no circumstances, could they cancel this plan because they are undergoing treatment. But, anyway, they don’t want to know,” he added.

Just last Saturday (4), lawyer Marcelo Lavezo filed 18 lawsuits on behalf of mothers of autistic children from Baixada Santista. There are cases in several cities, such as Praia Grande, Guarujá, Santos and Peruíbe. Marcelle and Dayah contacted him shortly after the administrator’s notification.

To the g1he recalled that Normative Resolution No. 195 of the National Supplementary Health Agency (ANS) says that contracts for private collective membership plans can only be terminated without reason upon prior notification from the other party at least 60 days in advance.

“This conduct has been characterized and recognized by the Judiciary as abusive. Because the person is in the middle of treatment, it is understood that when we take out a health plan it is because we need the treatment. So if this plan is canceled midway, it’s an unpleasant surprise, to say the least. Illegal and abusive”.

To the Court, he presented requests for injunctions – decisions given on an urgent basis – to try to reverse the situation and guarantee the continuity of treatments.

In a statement, Qualicorp stated that it had only been notified by Amil about the cancellation of the contracts. The company added that, as a benefits administrator, it sent the cancellation letter to customers, complying with the 30-day notice period, in accordance with the contract signed between the parties.

Finally, Qualicorp declared that it supports the beneficiaries themselves, providing information and guidance on the exercise of portability, according to the available portfolio and the operators’ marketing rules.