Amil customers fear plan break after change of control

Micro-entrepreneur Carlos Alberto Lopes Gonçalves, 59, is terrified. He and four other members of his family, including his 82-year-old mother, have had individual health plans from Amil since 1988. Together, the plans add up to a monthly fee of R$ 6,300.

Two years ago, he underwent a double surgical intervention, for a hiatal hernia and bariatric, which caused complications. The pandemic came and he ruled out any trip to the hospital. Now, as he prepared to continue treatment, he learned that Amil’s individual and family plans are changing hands and the accredited network is shrinking.

“People in my family have already been denied care in traditional laboratories that attended the plan, such as Delboni Auriemo”, he says. “I need the plan to restore my health and my mother, who is 82 years old, who suffers from high blood pressure and diabetes, cannot do without care”, says he, a partner at a cafeteria in Brooklin, south of São Paulo.

“We’re not garbage. We can’t be thrown away by a health plan operator. We’re not asking any favors to be served, we pay for the service.”

Amil, controlled by the American UnitedHealth, hired the bank BTG Pactual at the end of last year to buy its loss-making portfolio of individual and family health plans. It is deficient because the readjustment of these plans does not follow inflation and is regulated by the ANS (National Supplementary Health Agency). In 2021, for example, the agency indicated a negative adjustment of 8.2%, that is, individual plans had to decrease prices.

BTG arrived at Fiord Capital, an investment fund created in November last year. The fund would receive R$ 3 billion to take over the portfolio of 330 thousand users in the states of São Paulo, Rio de Janeiro and Paraná. Due to the operation designed for the change of control, APS, of the Amil group, would become responsible for individual and family health plans, a deal that was approved by the ANS.

But at the beginning of this year, APS passed to the command of Fiord – a movement that has just been barred by the ANS, which claimed that there was no information about the change in corporate control.

Amil is the third largest health plan in the country, with a 6.1% share. But the vast majority of its 3.4 million beneficiaries belong to business plans, which are profitable. In the fourth quarter of last year, UnitedHealth, the parent company of Amil, posted net income of $4 billion, up 84% year-on-year. Behind-the-scenes information reveals that UnitedHealth plans to leave the country, but to sell its assets well, it must first get rid of its loss-making customer base.

“Meanwhile, users of individual and family plans are in limbo, without transparent information about this negotiation and without the guarantee that the service will be maintained”, says lawyer Rafael Robba, from the Vilhena Silva office, specialized in the health sector. “Many of the users of these plans are middle-aged or elderly people, they pay dearly for the service, but they are seeing the accredited network being dried up overnight, without prior notice, which is against the legislation of the sector”, he says.

According to Robba, the law assures the holder of an individual or family health plan that the contract cannot be canceled by the operator, and that the company must notify at least 30 days in advance the disqualification of laboratories or hospitals, always taking care to offer another option of the same level, in the same location.

That’s not what happened to Maria de Fátima da Silva, 50, a micro-entrepreneur from São Paulo. She was unable to perform the tests ordered by her gynecologist at the Lavoisier laboratory. “I didn’t know that the laboratory left Amil’s network in October, I only found out when I went to do the blood collection”, she says, a client of the health plan for about nine years.

“This week, Amil sent a statement saying that the plan was now managed by APS, and that it would continue with the same accredited network. But it is a lie.”

Even in business plans, Amil has changed the network without notice. “In Indaiatuba (SP), the best hospital in the city – HAOC (Hospital Augusto de Oliveira Camargo) – was de-accredited in January”, says lawyer Camila Voic, who has a business plan for her, her husband and children.

For Robba, the ANS has not learned anything from the Unimeds crisis in the past decade, and assumes a merely reactive stance. “Actual inspection does not work in the ANS and the agency only expressed itself on the case because of the pressure that came out in the press”, says Robba. “Amil’s beneficiaries have reason to be distressed.”

Benjamin Wainberg, 68, is one of them. “I’ve been with Amil for 25 years and at this point in my life I need the security of a health plan. I even considered leaving the country and moving to Israel, where I know I can count on quality care”, says the administrator of retired companies. “From what I’ve seen, I predict that Fiord will take over Amil’s plans and go bust within a while, leaving thousands of customers in the lurch,” he says.

“I am insecure about the future of Amil and the performance of ANS”, says Wainberg, who pays around R$ 4,000 for a two-life family plan. “I can’t afford to go to another plan today, paying twice as much”, says the retiree, who in December had coverage for an exam refused by Amil. “I decided to pay the loss of R$ 1,600, to avoid the wear and tear of going to court against the plan.”

A different decision was taken by the family of business administrator Karinna Rodrigues, 43 years old. “In October, my mother-in-law had to undergo a heart valve replacement surgery and the cardiologist wanted to do the operation by robotic, less invasive, but Amil refused to pay for the operation”, she says. According to her, the plan said it would only pay for the cheapest procedure, which would involve opening the patient’s entire chest.

Faced with the impasse, the 71-year-old patient was hospitalized for 40 days. “We had to hire a lawyer to file a lawsuit against Amil, until the operator released the robotic operation,” she says. The in-laws pay together a monthly fee of around R$2,500 and have been Amil’s customers for over 30 years.

Melissa Kanda Dietrich, a partner at Farah Kanda Advogados, also specialized in the health area, says that users of Amil plans have the option of portability, which is the change of health plan without meeting the grace period. “It’s enough to be up to date with the monthly fee, to be a user of the plan for at least two years, to get a change to an equivalent plan”, she says.

As there are few options for family and individual plans on the market, the user would have to hire a collective administrator, such as Qualicorp, which in turn mediates with other health plans that do not serve individuals. “But in these cases the user may find himself with an accredited network inferior to what he had”, she says.

Procon-SP notifies companies to discuss transfer

This Tuesday (9), Procon-SP notified Amil, APS and UnitedHealth Group to discuss the transfer of the 330 thousand beneficiaries of individual and family plans. Companies should attend the institution’s headquarters, in São Paulo, on the 17th.

In a note, Idec (Brazilian Institute for Consumer Protection) stated that it is demanding answers from the ANS and the operator, in order to know what guarantees were presented by Amil and APS to ensure the continuity and quality of services.

Denis Morante, a partner at the investment advisory firm Fortezza Partners, says that it is not easy for Amil to maintain a loss-making operation in Brazil. “Health inflation, with its inputs and services, is triple the general inflation”, he says, noting that costs have grown even more with the pandemic. “Here comes the ANS and decides that, in 2021, the readjustment is down”, he says. “The business becomes unsustainable.”

Amil says he reviews the sales process

Questioned by leafAmil stated in a note that it is reviewing the process of buying and selling APS.

“UnitedHealth Group Brasil informs that it is reviewing the process of buying and selling Personalized Health Care (APS), in response to the questions raised by the regulatory agency. It reiterates that APS remains a company of the group and ensures that all conditions contracted by the beneficiaries remain strictly the same. Its service channels remain at the disposal of its beneficiaries for clarification”, says the text.

Fiord Capital did not respond to the interview request until the publication of this text.