Background
Unimed de Sorocaba Cooperativa de Trabalho Médico Hospital Dr. Miguel Soeiro sued Miguel Martins Mastromano and Wagner Chicarolli Martins for R$7,568.19 in medical expenses. It alleged that Miguel was admitted on April 11, 2023, using an authorization and membership card from a canceled Unimed São Roque plan and later presented a new card that could not cover the earlier admission. Unimed maintained that the treatment therefore became private and that a signed responsibility form obligated the patients to pay expenses denied by the insurer.
The trial court rejected the claim. It found no proof that the health plan had been canceled and observed that the charge concerned only a lens used during the procedure, rather than all treatment and hospitalization costs. It also found that Unimed had not informed the defendants beforehand which procedures and materials the plan covered. The São Paulo Court of Justice affirmed, concluding that Unimed had not proved contact with the insurer, cancellation of the plan, or adequate consumer disclosure.
Unimed sought special review, invoking the Civil Code provisions on contractual autonomy, social function, and objective good faith, as well as the Consumer Defense Code’s disclosure requirement. The STJ Presidency initially refused to hear its interlocutory appeal under STJ Precedent 182 for failure to challenge the grounds of the lower ruling specifically. Unimed then filed an internal appeal, arguing that it had addressed every relevant ground.
The Court’s Holding
The Fourth Panel unanimously granted the internal appeal and reconsidered the Presidency’s procedural ruling. It held that STJ Precedent 182 did not apply because Unimed’s interlocutory appeal had adequately challenged the grounds for denying special review. The Panel therefore entertained that appeal and proceeded to reassess whether the special appeal could be heard.
The court nevertheless declined to hear the special appeal under STJ Precedent 7. The state court’s judgment rested on factual findings that Unimed had not proved contact with the health insurer, cancellation of the patient’s plan, or advance disclosure of which procedures and materials were covered. Reversing those conclusions would require the STJ to reexamine facts and evidence, which is unavailable in a special appeal.
The STJ accordingly left the dismissal of the collection action intact. It also increased the defendants’ attorney-fee award from 13% to 14% of the updated amount in controversy under Article 85(11) of the Code of Civil Procedure.
Key Takeaways
- An internal appeal may cure an erroneous refusal to entertain an interlocutory appeal when the appellant did specifically challenge the grounds of the disputed ruling.
- The STJ will not use special review to revisit record-based findings about health-plan cancellation, insurer contact, or disclosure of uncovered medical materials.
- A hospital seeking direct payment from a patient must build a record supporting both the absence of insurance coverage and adequate advance disclosure of the patient’s financial responsibility.
Why It Matters
The ruling distinguishes procedural access from substantive review: Unimed successfully reopened the path to consideration of its interlocutory appeal but still could not obtain review of a special appeal dependent on reweighing evidence. For litigants before the STJ, adequately challenging a ruling’s grounds does not overcome the separate bar against factual reconsideration.
The decision also underscores the evidentiary importance of documenting insurer communications, plan status, coverage denials, and clear pre-procedure disclosures when healthcare providers seek to collect allegedly uncovered expenses directly from patients.