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  HEALTH LAW 

FULL  LEGAL ADVICE FOR INDIVIDUALS AND CORPORATIONS

  • Abusive readjustments in health insurance prices due to change in age range (from 59 or 60 years old) or due to casualties;

 

  • Maintaining the health insurance after retirement and resignation or dismissal;

 

  • Medical malpractice;

 

  • Refusal in disease coverage (such as oncology, cardiology, urology, orthopedics, etc), in surgeries, medications, home caring and other procedures. When it is due to preexisting diseases, grace period, retirement, divergence of medical opinions, procedures not listed within the National Health Agency, treatment or high cost medication, among others;

 

  •  Revision of medical and hospital expenses when repayment is requested;

 

  • Compensations, refund and/ or moral damage; 

 

  • Health insurance issues, such as:

​​​​​​​

​​​​​​​a) migrating from one plan to another;

b) change of category;

c) loss of accreditation;

d) grace period and preexisting diseases;

e) portability of grace period;

f) refusal of a beneficiary to join the insurance;

g) refund of medical and hospital expenses;

h) unilateral termination;

i) urgency and emergency;

j) refuse coverage, etc.  ​​​​​​​

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  • Defense of corporations' interests against health insurance companies;

 

  • Analysis of contracts in order to prevent risks and protect rights at the moment the service is contracted or the corporate insurance is renovated;

 

  • Preventive consultancy and filling lawsuits in cases of unilateral termination of corporate contracts, abusive readjustments due to casualties and matters involving maintaining insurance for former employees (retired, dismissed, etc)   
 SOME OF OUR VICTORIES

REFUSAL OF COVERAGE

 

CASE 1 -MRS. ADRIANA

Mrs. Adriana, bearer of malignant neoplasm, was indicated surgery. Her insurance Amil Assistência Médica Internacional (Amil International Medical Care) did not approve the procedure. Perisson Andrade Advogados office succeeded in having Mrs. Adriana's surgery at the insurance company's full expense in a first-rate hospital in São Paulo. The client received an indemnity for moral damages as well.

 

 

 CASE 2 - ALEXYA

Newborn Alexya's parents had to fill a lawsuit in such a delicate moment of their lives. All because CESP Foundation and Associação Congregação Santa Catarina - Hospital (Santa Catarina Congregation Association Hospital) refused to provide the necessary treatment to their baby. Perisson Andrade Advogados office succeeded in giving Alexya the treatment she needed without additional charges being made to her parents.

 

REIMBURSEMENT

 

CASE 1 - RODRIGO

Little Rodrigo had to be submitted to an emergency surgery, due to a severe kidney infection. SulAmérica Seguros (SulAmérica Insurance) did not have any uropediatric in their referenced network. Without options, the family hired a private specialist, as well as the necessary team, with a total of R$ 15.000,00. SulAmérica reimbursed only R$ 2.276,32. Perisson Andrade Advogados succeeded in making SulAmérica cover 100% of the amount paid, plus monetary correction.

 

CASE 2 - GUSTAVO 

The boy Gustavo was admitted to Albert Einstein Hospital with the diagnosis of pneumonia and respiratory failure. SulAmérica refused to reimburse medical expenses, even though the doctor belonged to the medical staff of the associated hospital. Perisson Andrade Advogados succeeded, by judicial process, in getting its clients reimbursed 100% of the amount paid. And, in addition, moral damages in the amount of R$ 3.590,00.   

 

ADJUSTMENT BY AGE GROUP - 60 YEARS OLD

With the effective date of the Elderly Statute, over ten years ago, health insurances are no longer allowed to make price adjustments by age group, starting from the age of 60.

 

 

 

CASE 1 - MRS. MAISA

Decision overruled abusive and illegal readjustment that the health insurance Unimed wanted to impose on Mrs. Maisa when she turned 60.

 

 

 

 

CASE 2 - MRS. MARIA INÊS

This summary jydgement determined the immediate suspension of abusive and illegal readjustment that SulAmérica wanted to impose on Mrs. Maria Inês when she turned 60.

ADJUSTMENT BY AGE GROUP - 59 YEARS OLD

When clients turn 59 years old, health insurance companies make one last price adjustment based on age, as an attempt to evade the Elderly Statute. And those increases can get to over 500%. Look at some cases of clients who got to see their health insurance bills reduced.

 

CASE 1 - MR. CHONG

SulAmérica Insurances made an abusive increase of 100% in Mr. Chong's monthly payment when he turned 59 years old. Perisson Andrade Advogados succeeded in making the company revoke the readjustment and the client received the amount unduly paid plus interest and monetary correction.

 

CASE 2- MR. RENATO

When he turned 59, Mr. Renato saw his health insurance payment increase by 131,73%. Perisson Andrade Advogados succeeded in revoking the increase in SulAmérica Health Insurance plan and managed to make its client to receive all the amount unduly paid plus interest and monetary correction.

 
 
 
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