Only 9 Small Companies Signed agreement Brazilian Healthy Care: ANS released a term of commitment for health plan operators promising an investment of up to R $ 15 billion to help combat covid-19.
Only 9 small companies signed an agreement
ANS released a term of commitment for health plan operators promising an investment of up to R $ 15 billion to help combat covid-19. In return, they should maintain assistance to defaulters, whether individual, family or collective contract with up to 29 people, until June 30, even if the delay in payment exceeds the 60 days established by law.
Only nine small businesses signed the term:
- Alice Operator
- AMHA Health
- Bio Health Medical Services
- HBC Health
- Med-Tour Benefits and Enterprise
- Polymedical Health
- Health Systems and Plans
- Terramar Administrator e
- Unimed do Sudoeste – Medical Work Cooperative
- Health chain at risk, says FenaSaúde
The main operators in the country
The main operators in the country, represented by FenaSaúde (National Supplementary Health Federation), decided not to join. In a statement, FenaSaúde stated that the increase in health care expenses because of the pandemic creates a challenge to adjust to its revenue, and the increase in defaults would only aggravate the situation.
“Currently, 85% of what is received by operators in the form of monthly fees is used to pay providers such as hospitals, laboratories, doctors and nurses. An increase in default could have the immediate effect of weakening the system at a time when the most it needs to be vigorous, “said Vera Velente, executive director of FenaSaúde.
According to her, the association made the request for release of funds from the ANS exactly “to keep the health system functioning well in case of worsening of the crisis”, and the adoption of the clause would put “the entire health chain” at risk.
In return, FenaSaúde said, the association suspended the increase in all monthly fees until the end of July.
In response, ANS affirmed that “the composition of an agreement that only generates advantages to the operators does not find legal support”.
Without agreement, situation does not change due to pandemic
Without agreement, with the exception of customers of the nine operators mentioned above, the legislation remains the same. In the event of default, termination of the contract may occur if the monthly payment is not paid for 60 days, consecutive or not, within a period of 12 months.
Procon states, however, that the consumer must be notified by the operator by the 50th day of default. “The notification sent must contain the identification of the operator, the beneficiary, in addition to the health insurance contracted, and the number of days of default and consequences”, informs the agency.
If this clause is not met by the operator, the consumer can appeal and reactivate the plan through payment, and ANS can fine the company.
It takes balance between two parties, says lawyer
Although there is a legal basis, lawyer Arthur Rollo, a former National Consumer Secretary, says that health plans cannot cut out assistance from a considerable slice of his clients. According to him, there needs to be balance.
“I paid for my plan 20, 30 years ago. As a result, I lose my job in the crisis and stop paying, but I need assistance. If they cut in the middle of the pandemic, the judge is very likely to give the consumer a reason”, exemplified Rollo.
“If there is radicalization on the part of the plans to cut all defaulters based on the cold letters of the law, it will inevitably end up in the Judiciary Branch, which may have a different interpretation. It will rain an injunction to determine which health plan covers treatment,” said the lawyer.
Likewise, he said he understands that health plans are, in fact, going through an atypical phase, of many expenses, and he believes that consumers cannot deliberately stop payments either.
“At the other extreme, if a large party stops paying [monthly fees], the plan breaks down and no one has assistance. If you can’t pay everything, you try to pay 80%, negotiate. You need a game of balance, balance between the two parties “said Rollo.
How to complain
If the consumer feels that their rights have been violated, it is possible to report them to ANS, which is the regulatory agency, or to Procon in your state.
If there is still no resolution, it is possible to judicialize the process.