Motivos jurídicos de os planos de saúde negarem as cirurgias plásticas reparadoras aos pacientes submetidos à cirurgia bariátrica no estado do Rio Grande do Sul
Loading...
Date
2023-06
Authors
relationships.isAdvisorOf
Fontana, Eliane
relationships.isRefereeOf
Lawisch, Gabriela Kniphoff da Silva
Fröhlich, Sandro
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Trata-se de um trabalho monográfico, cujo objetivo geral é analisar o repositório jurisprudencial do Tribunal de Justiça do Rio Grande do Sul acerca das negativas dos planos de saúde privados à cobertura das cirurgias plásticas reparadoras aos pacientes que foram submetidos à cirurgia bariátrica. A obesidade é uma doença reconhecida pela OMS e um de seus tratamentos se dá pela intervenção cirúrgica através da cirurgia bariátrica. Após o emagrecimento, o paciente submetido ao procedimento bariátrico, e quando superada a obesidade, resta-se com os danos causados pela obesidade, seja com as sobras de pele em diversas regiões do corpo, além de dermatites que causam sofrimento físico e psicológico. A problemática é responder à luz das decisões pesquisadas no site do Tribunal de Justiça do Rio Grande do Sul, entre os anos de 2014 a 2022, quais os motivos recorrentes levam os planos de saúde privados a negarem cirurgias plásticas reparadoras aos pacientes submetidos à cirurgia bariátrica, uma vez que tal procedimento é necessário à continuidade do tratamento da doença obesidade. Como hipótese, levanta-se o argumento do plano de saúde por entender que se trata de procedimento estético que não integra o rol de procedimentos previstos na ANS. Busca identificar os motivos pelos quais os planos de saúde privados negam administrativamente as cirurgias plásticas reparadoras aos pacientes que foram submetidos à cirurgia bariátrica, uma vez que trata-se de continuidade ao tratamento da doença obesidade, fazendo com que os pacientes necessitam buscar a tutela jurisdicional para ver reconhecidos seus direitos. A metodologia desta monografia caracteriza-se por ser de cunho dedutivo, consiste em aplicar o conhecimento e experiência adquirida ao longo da pesquisa. O método de abordagem é quali-quantitativo, com finalidade exploratória e descritiva, com recurso técnico bibliográfico através de doutrinas, análise de conteúdo pelas jurisprudências do Tribunal do Tribunal do Rio Grande do Sul e, com realização de estudo de caso, através de questionário pelo Google Formulários.
This is a monographic work that aims to analyze the jurisprudential repository of the Court of Justice of Rio Grande do Sul about the denials of private health insurance plans to the coverage of reconstructive plastic surgeries for patients who underwent bariatric surgery. Obesity is a disease recognized by the WHO and one of its treatments is surgical intervention through bariatric surgery. After losing weight, the patient undergoes a bariatric procedure, and when the obesity is overcome, they are left with the damage caused by it, whether with excess skin in different regions of the body, or also dermatitis that causes physical and psychological suffering. The problem is to respond in the light of the decisions researched on the Court of Justice of Rio Grande do Sul’s website, between the years 2014 to 2022, which are the recurring reasons that lead private health insurance plans to deny reconstructive plastic surgeries to patients undergoing bariatric surgery, since this procedure is necessary for the continuity of the obesity treatment. As a hypothesis, the health insurance plan argues that it understands that it is an aesthetic procedure that is not part of the list of procedures provided for in the ANS. The study seeks to identify the reasons why private health insurance plans administratively deny restorative plastic surgeries to patients who have undergone bariatric surgery, since it is a matter of continuing the obesity treatment, rendering the patients in need to search for judicial protection to have their rights recognized. The methodology of this monography is characterized by being of a deductive nature, consisting of applying the knowledge and experience acquired throughout the research. The method of approach is quali-quantitative with exploratory and descriptive purposes, using a bibliographic technical resource through doctrines, content analysis by the jurisprudence of the Court of Rio Grande do Sul, and with the accomplishment of a case study through a questionnaire made using Google Forms.
This is a monographic work that aims to analyze the jurisprudential repository of the Court of Justice of Rio Grande do Sul about the denials of private health insurance plans to the coverage of reconstructive plastic surgeries for patients who underwent bariatric surgery. Obesity is a disease recognized by the WHO and one of its treatments is surgical intervention through bariatric surgery. After losing weight, the patient undergoes a bariatric procedure, and when the obesity is overcome, they are left with the damage caused by it, whether with excess skin in different regions of the body, or also dermatitis that causes physical and psychological suffering. The problem is to respond in the light of the decisions researched on the Court of Justice of Rio Grande do Sul’s website, between the years 2014 to 2022, which are the recurring reasons that lead private health insurance plans to deny reconstructive plastic surgeries to patients undergoing bariatric surgery, since this procedure is necessary for the continuity of the obesity treatment. As a hypothesis, the health insurance plan argues that it understands that it is an aesthetic procedure that is not part of the list of procedures provided for in the ANS. The study seeks to identify the reasons why private health insurance plans administratively deny restorative plastic surgeries to patients who have undergone bariatric surgery, since it is a matter of continuing the obesity treatment, rendering the patients in need to search for judicial protection to have their rights recognized. The methodology of this monography is characterized by being of a deductive nature, consisting of applying the knowledge and experience acquired throughout the research. The method of approach is quali-quantitative with exploratory and descriptive purposes, using a bibliographic technical resource through doctrines, content analysis by the jurisprudence of the Court of Rio Grande do Sul, and with the accomplishment of a case study through a questionnaire made using Google Forms.
Description
Keywords
Direito à saúde; Direito Constitucional; Direito do Consumidor; Obesidade; Planos de Saúde; Tema 1069 STJ; Right to health; Constitutional Law; Consumer Law; Obesity; Health insurance plans; Theme 1069 STJ
Citation
COSSA, Kelly. MOTIVOS JURÍDICOS DE OS PLANOS DE SAÚDE NEGAREM AS CIRURGIAS PLÁSTICAS REPARADORAS AOS PACIENTES SUBMETIDOS À CIRURGIA BARIÁTRICA NO ESTADO DO ESTADO DO RIO GRANDE DO SUL. 2023. Monografia (Graduação em Direito) – Universidade do Vale do Taquari - Univates, Lajeado, 27 jun. 2023. Disponível em: http://hdl.handle.net/10737/3670.