A federal court ordered a Prepaid medications Providing immediate, complete and prompt coverage of a hormonal treatment Indicated for a girl diagnosed with short stature Disabled ID cardas the right to health of a minor is directly at stake.
The judgment was handed down by the Federal Judge of Civil, Commercial and Administrative Litigation in San Martín, Oscar Papavero, who emphasized that in conflicts between rights, the best interests of the child must prevail, a principle enshrined in the state constitution and in international treaties with a constitutional hierarchy.
The legal action was initiated by the girl’s parents OSDE prepaid I would refuse to cover this completely Medicine Leuprolide Lectrumprescribed by the attending physician as part of a comprehensive treatment of pathology.
The rejection of prepaid and the partial insurance offered
According to the protocol The company had only offered to cover 40% of the treatment, arguing that the diagnosis did not meet current regulatory criteria.. In this sense, he claimed that the drug was indicated for girls under 8 years old, while the patient was 9 years and 9 months old at the time of prescription.
However, The judge rejected this suggestion. and emphasized that health care services must be comprehensive, equitable and timely, and that both social welfare agencies and prepaid medical companies are obliged to respond quickly and effectively when a properly recognized medical need exists.
A central element of the judgment was the report from the Forensic Medical Corps, which supported the indication for treatment and detailed the minor’s clinical situation. The experts explained that children who are born with intrauterine growth retardation and do not achieve early compensatory growth often have one significantly smaller adult size.
In the case analyzed, they pointed out that the girl had a rapidly progressing puberty, was initially small in height and a unfavorable prognosis for the final sizewhich justified the use of the drug as an adjunct to growth hormone treatment.
“The goal is to stop the puberty surge so that you can do that Improve your final adult size“pointed out the specialists, who also emphasized that it is an effective and safe treatment with few and reversible side effects.
The report added that the therapy could even promote a better match between pubertal development and the girl’s overall performance.particularly taking into account the difficulties associated with his disability.
The court decision and the order for immediate coverage
Judge Papavero emphasized that the conclusions of the Forensic Medical Corps were not considered or refuted with appropriate technical or scientific bases, and therefore it is appropriate to give them full probative force.
The operative part of the judgment states: directed OSDE to ensure comprehensive drug coverage on a regular basis and without bureaucratic hurdlesand established certain guidelines to ensure continuity of treatment. In addition, it ordered the defendant company to pay the costs of the lawsuit.
“The social work conduct was incompatible with effective health care for the patient,” the judge concluded, taking into account the diagnosis, the medical indication and the health care provider’s legal obligation to ensure coverage of the prescribed treatment.
Similar case in Mendoza: The judiciary decided that the hormone treatment had to be paid for in full
Days ago, that Federal judiciary de Mendoza ruled that a prepaid drug company must guarantee full coverage for the drugs Hormone treatment of an eleven-year-old boy.
The youngest suffers from GH deficiency, a condition that can be achieved without the right approachirreparable problems” in their health and development. The Federal Court of Appeal of Mendoza supported the minor’s right to health. This ruling sets a significant precedent in protecting patients’ rights.
The news took on greater importance because it concerns an illness similar to that suffered by Lionel Messi when he had to emigrate to Spain to undergo treatment paid for by the Barcelona club.
The Mendoza Federal Court of Appeal decision came after the prepaid company refused to provide comprehensive insurance coverage. The company only offered 40% of the total cost, leaving the family responsible for a significant difference. According to an email, that number was $1,023,903.60. The court decision puts the child’s health ahead of the company’s financial objections.
In their ruling, the judges emphasized that the child’s health may suffer “irreparable problems.” They claimed that the court decision sought the solution “Better harmonize the human rights at stake”thereby removing barriers that prevented access to necessary treatment. You can find more information about outages at prepaid companies here.
The court emphasized that contrary to the company’s arguments for prepaid drugs, growth hormones are specifically provided for 100 percent coverage in APE Resolution 500/04. In addition, the judges recalled that the Mandatory Medical Program (PMO) sets a “floor limit for minimum rather than maximum benefits,” suggesting that insurance coverage should not be limited. This point strengthens the commitment of healthcare providers.
The board emphasized that when a person makes a claim against a prepaid company, what is at stake is: “Right to health, his psychophysical integrity, his fullness and his security.” In this context it was found that the “Best interests of the child” should always be at the forefront of any legal decision. The provision aims to ensure the fulfillment of the minor.
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