Complaints against Amil grow almost 50% in two years, says ANS

The number of complaints from customers of the health operator Amil with the ANS (National Agency for Supplementary Health) grew 47% between 2019 and 2021, from 19,000 to 28,000, according to a survey carried out by the agency at the request of the leaf.

In the last month of January alone, 2,751 complaints were registered against Amil, more than double the 1,308 registered in January 2021.

The 47% increase in the number of complaints against Amil in the last three years surpassed the 41% increase in the number of complaints against health plans as a whole in the period.

According to the regulatory agency, there were 190,741 complaints from health insurance users last year. Of these, 14.7% are against Amil (with 28,005 complaints from consumers). Amil’s main problem is related to the “management of health actions by the operator” – which, as indicated by the ANS, encompasses issues such as prior authorizations, deductibles and co-participation, and represented 18.7% of the complaints against the company in 2021.

The second main reason for complaints (17.6%) last year concerns the suspension and termination of contracts. Third in the 2021 complaints ranking, with 17% of the total, is reimbursement.

THE leaf contacted Amil to find out the reasons for the increase in the number of complaints, but it was not answered until the publication of this text.​

In January of this year, when the transfer of Amil’s portfolio of individual and family plans was underway – first to APS, a group company, and then to the Fiord Capital investment fund – complaints totaled 2,751. The “management of health actions by the operator” was the main problem in the period (20% of complaints), closely followed by difficulties in covering the service network (18.2%) and contract suspension and termination (11, 5%).

Report of this Wednesday (9) of the leaf pointed out cases of customers distressed with the imminent change of hands of Amil’s individual and family plans. According to reports, the company’s accredited network has shrunk in recent months without warning, which is against the law. The health plan must notify the consumer 30 days in advance about the disqualification of a particular hospital or laboratory – and must present an alternative of the same level to the customer, in the same region.

The negotiation of the sale of Amil’s portfolio of plans to individuals was barred on Tuesday night (8) by the ANS. In a statement, the agency said that since January 2 this year, APS, of the Amil group, has been responsible for assisting the 330,000 beneficiaries of the company’s individual and family plans in São Paulo, Rio de Janeiro and Paraná.

ANS stated that it had questioned Amil about the acquisition of control of APS by Fiord, the financial capacity of the new partners to guarantee the sustainability of the operator and the value involved in the operation. “Without satisfactory answers, the board decided to follow the technical guidance of suspending the withdrawal of the current controller of the Amil group from the membership at this time.”

Source: ANS

In Procon de São Paulo, complaints against Amil shot up between 2019 and 2021. According to the agency, last year, there were 1,969 complaints, against 554 in 2019, an increase of 255% in the period. In a statement released this Thursday (10), the director of Procon-SP, Fernando Capez, says he is studying filing a lawsuit to cancel the transfer of Amil’s health plans to APS.

In a note to leaf, ANS reported that the agency “is the main channel for receiving demands from users of health plans in the country and acts strongly in the intermediation of conflicts between beneficiaries and operators, through the Preliminary Intermediation Notification (NIP), a tool created by ANS to expedite the resolution of problems reported by consumers and that has more than 90% resolution”. With that, it seeks to avoid the judicial conflict, says the ANS.

Through the NIP, the complaint registered in the service channels of the agency is automatically sent to the responsible operator, who has up to five working days to resolve the beneficiary’s problem in cases of non-guarantee of assistance coverage, and up to ten working days in cases of non-assistance demands.

If the problem is not resolved by the NIP, says the ANS, an administrative procedure can be opened, even resulting in the imposition of a fine against the operator.

The ANS advises users that, if the problem is not resolved with the health plan, the complaint is registered with the regulatory agency. The service channels are Dial ANS 0800 701-9656, the electronic form on the portal www.gov.br/ans/pt-br and the call center for the hearing impaired 0800 021 2105.

APS says it is capable of bringing improvements to the service

In a statement released this Thursday (10), the candidate group to take over the individual plans of the Amil group said that there will be no harm to the beneficiaries.

“The closing of the deal is premised on the maintenance of all the rights of the beneficiary as well as the service structure”, says the note, which also informs that the group is made up of partners from the company Seferin & Coelho, by the executive Henning von Koss and by Nikola Lukic, who founded investment manager Fiord Capital.

“The group, before participating and winning a very competitive process, looked into and studied the feasibility of managing the APS portfolio and believes that the business is not only financially viable but, through technology and with the partners’ experience, will be possible to bring improvements to the service provided”, says the group in the note.