{"id":45816,"date":"2025-08-18T06:13:41","date_gmt":"2025-08-18T09:13:41","guid":{"rendered":"https:\/\/justicapotiguar.com.br\/?p=45816"},"modified":"2025-08-18T06:13:41","modified_gmt":"2025-08-18T09:13:41","slug":"plano-de-saude-e-condenado-a-reembolsar-paciente-que-custeou-cirurgia-de-glaucoma","status":"publish","type":"post","link":"https:\/\/justicapotiguar.com.br\/index.php\/2025\/08\/18\/plano-de-saude-e-condenado-a-reembolsar-paciente-que-custeou-cirurgia-de-glaucoma\/","title":{"rendered":"Plano de sa\u00fade \u00e9 condenado a reembolsar paciente que custeou cirurgia de glaucoma"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"1000\" height=\"667\" src=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2025\/08\/2149352203.jpg\" alt=\"\" class=\"wp-image-45818\" srcset=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2025\/08\/2149352203.jpg 1000w, https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2025\/08\/2149352203-300x200.jpg 300w, https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2025\/08\/2149352203-768x512.jpg 768w\" sizes=\"(max-width: 1000px) 100vw, 1000px\" \/><figcaption>Foto: Freepik<\/figcaption><\/figure>\n\n\n\n<p>A 1\u00aa Turma Recursal do RN manteve a condena\u00e7\u00e3o de um plano de sa\u00fade ao reembolso de R$ 13.500,00 a benefici\u00e1ria que custeou cirurgia oftalmol\u00f3gica fora da rede credenciada. A paciente, em quadro de glaucoma maligno, alegou aus\u00eancia de prestadores dispon\u00edveis e realizou o procedimento em hospital particular.<\/p>\n\n\n\n<p>O plano recusou o reembolso, alegando inexist\u00eancia de urg\u00eancia e limita\u00e7\u00e3o pelos valores da sua tabela interna. Contudo, o relator, juiz Jo\u00e3o Afonso Morais Pordeus, destacou que a operadora n\u00e3o comprovou disponibilidade da rede credenciada nem apresentou contrato com cl\u00e1usulas sobre reembolso. Ressaltou ainda que, mesmo sendo plano de autogest\u00e3o, h\u00e1 responsabilidade civil pela falha em garantir tratamento essencial.<\/p>\n\n\n\n<p>Diante da omiss\u00e3o da operadora, os ju\u00edzes determinaram reembolso integral, rejeitaram a limita\u00e7\u00e3o pela tabela interna e condenaram o plano ao pagamento de custas e honor\u00e1rios. O pedido de danos morais, por\u00e9m, foi negado por falta de comprova\u00e7\u00e3o de preju\u00edzo extrapatrimonial relevante.<\/p><div class=\"eqvom69e0863464aee\" ><!--<a href=\"https:\/\/bit.ly\/3QdrqTZ\" target=\"_blank\">\n<img src=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2023\/09\/mobile-geral.gif\"\/><a\/>--><\/div><style type=\"text\/css\">\r\n.eqvom69e0863464aee {\r\ntext-align: center;\r\n}\r\n@media screen and (min-width: 1201px) {\r\n.eqvom69e0863464aee {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (min-width: 993px) and (max-width: 1200px) {\r\n.eqvom69e0863464aee {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (min-width: 769px) and (max-width: 992px) {\r\n.eqvom69e0863464aee {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (min-width: 768px) and (max-width: 768px) {\r\n.eqvom69e0863464aee {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (max-width: 767px) {\r\n.eqvom69e0863464aee {\r\ndisplay: block;\r\n}\r\n}\r\n<\/style>\r\n<div class=\"iwgqv69e0863464adb\" ><!--<a href=\"https:\/\/bit.ly\/3QdrqTZ\" target=\"_blank\">\n<img src=\"https:\/\/justicapotiguar.com.br\/wp-content\/uploads\/2023\/09\/desktop-geral.gif\"\/><a\/>--><\/div><style type=\"text\/css\">\r\n.iwgqv69e0863464adb {\r\ntext-align: center;\nmargin-bottom: 1em;\r\n}\r\n@media screen and (min-width: 1201px) {\r\n.iwgqv69e0863464adb {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (min-width: 993px) and (max-width: 1200px) {\r\n.iwgqv69e0863464adb {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (min-width: 769px) and (max-width: 992px) {\r\n.iwgqv69e0863464adb {\r\ndisplay: block;\r\n}\r\n}\r\n@media screen and (min-width: 768px) and (max-width: 768px) {\r\n.iwgqv69e0863464adb {\r\ndisplay: none;\r\n}\r\n}\r\n@media screen and (max-width: 767px) {\r\n.iwgqv69e0863464adb {\r\ndisplay: none;\r\n}\r\n}\r\n<\/style>\r\n\n\n\n\n<p>A decis\u00e3o refor\u00e7a que operadoras de sa\u00fade t\u00eam o dever de assegurar tratamento adequado e imediato, n\u00e3o podendo transferir ao consumidor os riscos da m\u00e1 organiza\u00e7\u00e3o ou da aus\u00eancia de rede credenciada dispon\u00edvel.<\/p>\n\n\n\n<p><em>Com imforma\u00e7\u00f5es do TJRN<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A decis\u00e3o refor\u00e7a que operadoras de sa\u00fade t\u00eam o dever de assegurar tratamento adequado e imediato, n\u00e3o podendo transferir ao consumidor os riscos da m\u00e1 organiza\u00e7\u00e3o ou da aus\u00eancia de rede credenciada dispon\u00edvel.<br \/><a class=\"more-link\" href=\"https:\/\/justicapotiguar.com.br\/index.php\/2025\/08\/18\/plano-de-saude-e-condenado-a-reembolsar-paciente-que-custeou-cirurgia-de-glaucoma\/\">Mais&#8230;<\/a><\/p>\n","protected":false},"author":8,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts\/45816"}],"collection":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/comments?post=45816"}],"version-history":[{"count":3,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts\/45816\/revisions"}],"predecessor-version":[{"id":45820,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/posts\/45816\/revisions\/45820"}],"wp:attachment":[{"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/media?parent=45816"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/categories?post=45816"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/justicapotiguar.com.br\/index.php\/wp-json\/wp\/v2\/tags?post=45816"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}