You are Arbitrary modifications to health plans It caused more people to go to court to request a reduction in the monthly fees charged by operators.
Survey obtained exclusively by R7 Save With the TJ-SP (Court of Justice of the State of São Paulo) an increase of 1,617% in the volume of proceedings questioning the increase in health plans between December 2018 and December 2020. Cases jumped from 128 to 2,199.
Compared to June 2020 and June 2021, the period covid-19 pandemicThe rise in lawsuits questioning health insurance readjustments was 9%, from 1,082 to 1,179.
For attorney Alexander Perth, who specializes in consumer law and health plans, the increase is very significant and illustrates the consequences of the crisis in the lives of Brazilians.
The lawyer believes that these numbers show that Brazilians have realized that it is possible to claim their rights and are beginning to notice that by filing lawsuits, they are achieving this.
“It is not possible to generalize and say that all actions will have favorable decisions in court, but it is a way of enforcing consumer protection law.”
Perth points out that “health plan operator contracts have fat and there are at least legal discussions.”
“Particularly in the case of group plans in which operators tie the readjustment to their loss rate and send only a letter justifying increases above the rates set by the ANS [Agência Nacional de Saúde Suplementar]Perth says.
Attorney Rafael Ropa, of Vilhena Silva Advogados, believes that procedures asking for coverage of medical procedures and questioning the adjustments applied by health plan operators are most sought after by consumers when it comes to health insurance.
While individual plans, which contain the ANS adjustment, suffered a correction of only 8.14%, Procon-SP set a monthly fee for group and group plans that suffered an increase of up to 150%, a percentage considered abusive and unjustified.
In the case of business plans, there is another aggravating factor. Because it involves negotiations between the company and the health plan operator, the consumer is left with their hands tied, without being able to question the company directly about the adjustment.
Modifications are suspended in 2020 due to the pandemic
The novel coronavirus pandemic has prompted the ANS to scrap health plan adjustments in 2020, with a promise to implement the patch this year in a watered down form within 12 months.
Relief, which has been a necessity for many families in the midst of the financial crisis, has been a major concern since the beginning of the year by many consumers receiving their bills. Arbitrary modifications to agreements.
Procon-SP has even notified the following health plan operators to classify abusive increases:
• Emil
• Bradesco
• Notre Dame
• Qualicorp
• South america
How do you reach?
Procon-SP provided a very prominent link on its website with the call Submit your complaint For the consumer to make a complaint.
See step by step:
• Log in to the system. If this is your first access, you must register your personal data;
• Next, click on “New Complaint” also in yellow, and fill in the required information. If you are the plan holder, click “I am a purchase or contract holder” before starting the claim;
• Next, click on the rating and find the item “Health”.
• After that, it is necessary to add the data of the operator of the health plan: full name, CNPJ, address, phone and e-mail;
• The next step is to save and apply.;
• On the other page, a space will appear for the consumer to put his health insurance card number, contract date, plan type (commercial or group) and the amounts paid before and after the modification;
• Click Next and write down what happened in a few words: the complaint was not accepted from the plan and the modification continued;
• In the box below your justification, select Review monthly fees and attach receipts;
• Finally, click Submit.
How do you file a claim?
Rupa says fairness has been very favorable to the consumer when the operator does not show transparency when it comes to the applicable adjustment rates.
Perth advises consumers who wish to file a lawsuit to ask the operator the payment history of the last four years to show the evolution of the health plan account.
It is also important to request a copy of the service contract to check the terms covered.
After that, the consumer has three paths: filing a complaint in the ANS, filing a formal complaint in Procon-SP or notifying the operator through the notary’s office.
If none of them work, there is still the option to file a lawsuit.
However, Perth cautions that even if the user receives an injunction – a temporary decision – to suspend the increase, it is not guaranteed that the final judge’s opinion will be positive.
Berthe and Robba both claim that the STJ (Supreme Court of Justice) issued a favorable consumer opinion.
“The courts have understood that the operator has a duty to be transparent. They can apply the loss ratio, but they need to justify how they arrived at the adjustment value.”
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