Home care suspension by health plan causes anger among families in Campinas region

Unimed Campinas suspends home health care service

The suspension of the home care service provided by a health plan has caused anger among some families in the Campinas region (SP) who have bedridden people and depend on special care from medical teams. They were informed of the interruption on Friday (12), and this Monday (15) they have not received a nursing visit.

The service is called Unimed Campinas Home Care (Aduc), and it consists of nurses who take care of bedridden patients on a daily basis.

Unimed claims that although it is not included in the mandatory coverage list of the National Agency for Complementary Health (ANS), the service is provided, but has “eligibility criteria”, and that some families will now rely on assistance in the form of guidance – See the full post below..

The President of the Health Law Committee of OAB Campinas, Vanessa Senhorini, highlighted that in many cases the suspension of care is arbitrary and that legal representation against the health plan is justified.

“What the plans claim is that this procedure is not listed on the ANS list, which is a common practice. When a person receives a plan denial, they should seek out a specialized attorney to analyze the case, and check whether the medical record highlights the care that is being withdrawn if it is abusive, the solution is to seek justice. In many cases, even if it is not listed on the ANS list, the patient has a right to care.”

The family of Jose Aparecido, 57, says he has received home care for six years, and that the work of health professionals is essential for basic care, such as bathing, diet and movement so that the body does not form wounds.

After suffering two heart attacks and seizures, his daughter Noemi Silva says her father was in a “vegetative state” and relied on 24-hour nursing care to stay alive.

However, they received a phone call last Friday (12) from Unimed informing them of the service being stopped, which actually happened on Monday (15).

“It was very difficult. He depends on 24-hour nursing care to survive. I tried to contact them, but they didn’t give me any justification. I feel unfair. I need to work, my mother can’t do everything on her own. It’s his right, he paid the insurance all these years, the monthly fees are paid, and there is a medical report proving the need for this care,” Al-Naimi highlights.

Noemi and her mother talk about the care her father, José Aparecido, 57, has needed for six years, and whose health plan stopped covering him on Monday (15) – Photo: Clausio Toffoloni / EPTV

Marcia Lima is in a similar situation, as her husband, Isaltino Aparecido de Lima, 58, has been dependent on home care for three years. Bedridden after a heart and respiratory arrest due to Covid-19, he returned home after 58 days of hospitalization.

Without nursing care this Monday, she says she's desperate, because she relies on the health plan.

“It was a huge scare, I felt sick, I cried since the day I got the news. I am alone, it is very difficult for me to take care of him. It is difficult for one person to bathe him, change his diaper, suction his trachea.”

In a note, UNIMED noted that among the eligibility criteria for Aduc was the use of mechanical ventilation, which was not the case in the two patients. See statement:

“Unimed Campinas Home Care is the special and exclusive service offered by Unimed, although it is not included in the mandatory coverage list of the National Agency for Complementary Health. This service aims to humanize the monitoring of patients with different degrees of dependence in their activities.

For this type of assistance, there are eligibility criteria that define each patient's needs, such as 24-hour nursing for those who need home treatment and the use of mechanical ventilation.

Home care for patients with other complexities requires the role of the family caregiver, who guides the care team in patient care.

According to the eligibility criteria that are periodically analyzed by Unimed Campinas, the patients who appear in the report are not undergoing mechanical ventilation treatment, therefore they no longer require full-time nursing and will now depend on assistance in the form of guidance from the care team. As are the other 350 patients in the same circumstances.”