Amil sells a portfolio of individual plans. What should the customer do? – 10/12/2021

Health business Amell, which belongs to United Health Group, will transfer its portfolio of individual health plans to investment firm Fjord Capital. APS (Personal Healthcare) is taking over the business, in a deal worth R$3 billion.

This information was published by the newspaper Valor Ecomico. the UOL I called Emile, but the company wouldn’t comment. Until the publication of this text, the company had not made any public statement on the issue.

Beware of contract changes

However, it does raise questions for health plan beneficiaries. Users must be aware of any changes not provided for in the contract in order to preserve their rights.

This market movement tends to give the consumer headaches, says Marcos Batulo, an attorney who specializes in right to health and partner at Vilhena Silva Advogados.

As an example, he cites the sale of the Golden Cross wallet to Unimed-Rio, in 2013. “There was a promise to maintain the network, but what was seen was an extensive court ruling that hurt customers from losing hospitals for example.”

Patulo suggests that Amil recipients be aware of any health plan changes. Also, they use trusted complaints channels, such as the ANS (National Agency for Complementary Health), a body linked to the Ministry of Health.

Ask the questions below, with guidance from Patullo:

What can change for the customer?

In theory, the operators say that nothing will change for the beneficiary, and that the value of the plans and network will remain the same. In practice, when this type of movement occurs, recipients suffer. It is a frequent practice to reduce the service network. The lawyer says beneficiaries are losing sight of the hospitals they used to use.

Can the new manager raise prices?

The ANS, under the Health Plans Act, ensures that the monthly fee is maintained. In the event of canceling the accreditation of a hospital, doctors or clinics, the new company shall replace it with an equivalent one. The lawyer says this is a personal matter. “What is the equivalent? The beneficiary wants to maintain her hospital.”

Is it possible to change the approved network?

No, but the ANS should monitor the group, especially if the authorized service network is to be maintained. It is what affects the user the most day in and day out.

“I am not necessarily saying that this will happen [com a Amil], but from what I have seen in other cases, I think there may actually be a change in the service provided to these beneficiaries,” Patulo stated.

In case of irregularities, what should the user do?

It is essential that you are very attentive to the communications and potential changes that will be received from the new plan manager to see if the service and hospital network will be maintained.

ANS provides online channels, such as Grievances Secretary it is in Initial mediation noticeWhich allows recording complaints and notifications of potential violations.

What if the problem is not resolved?

It is interesting to submit the complaint to the ANS first. However, if nothing is resolved, the beneficiary can file a lawsuit to ensure the maintenance of the network or even its equivalent.

The procedures are usually quick. In the state of São Paulo, restraining orders are usually estimated in less than a week. The lawyer says that the procedures in the judiciary were satisfactory.