See the rights of SulAmérica customers after purchasing through Rede D’Or

The purchase of SulAmérica by the hospital group Rede D’Or, announced this Wednesday (23), should not bring immediate changes to the insurance company’s customers, according to specialists consulted by the sheet. Although companies deny that there will be changes, lawyers and consumer protection organizations, such as Procon, reveal concern about the accredited network and the concentration of the sector.

As a rule, the incorporation cannot lead to changes that harm the insured, whether in the monthly fee, readjustment index or contractual conditions. The announcement, however, deepens the trend of verticalization in the health sector: when institutions become owners of all fronts of medical care, such as clinics, laboratories and hospitals.

To the report, the insurance company informed that the client of SulAmérica will continue to use its products and services in the same way as it currently uses. The association between the businesses, which needs to be approved by the ANS (National Supplementary Health Agency) and the companies’ shareholders, will be made through the unification of the shareholder bases.

In a statement released to the market, the companies said they will continue to operate independently in their sectors.

“SulAmérica will keep its commitments to its more than 7 million customers, 30 thousand brokers and commercial partners, and more than 23 thousand contracted service providers. Rede D’Or, in turn, will continue to offer the best long-term commercial relationships more than 300 partner operators and their patients the best that contemporary medicine can offer”, says the text.

According to ANS data compiled by Lafis Consultoria, Sulamérica is the fifth largest health plan in the country in terms of number of beneficiaries. Of the total of 7 million customers, the company claims that about 4.4 million are in the portfolio of collective health and dental plans, with the remainder in life insurance, pension plans and investments.

Melissa Dietrich, a partner at Farah Kanda Advogados, specialized in the health area, says that the company must maintain the same accredited network, type of coverage, contract, monthly fee, readjustment index and co-participation.

According to her, what may vary are bureaucratic issues, such as service channels and refund centers, for example. Still, policyholders need to be notified in advance.

“Once authorized [a operação] by ANS, a deadline will be established and all SulAmérica clients will need to be individually informed that, from a certain date, the insurance will be managed by another company [se for o caso]”, it says.

ANS needs to approve business

Sought to explain what can happen to SulAmérica’s customers, ANS limited itself to saying that the operation still needs to be submitted for approval and that it will wait for the presentation of the necessary documentation.

Rafael Robba, a lawyer specializing in health rights at the Vilhena Silva office, says that approval of the transaction is legally viable, provided that Rede D’Or manages to guarantee that it has the economic capacity to maintain its client portfolio with the same contractual conditions as the SulAmérica’s customers have today.

The lawyer recalls that, recently, the negotiation process of Amil’s plan administrator was barred for these reasons. In the decision, taken on the 8th, ANS questioned the financial capacity of the partners involved in the operation.

At the beginning of the month, the sheet showed cases of customers distressed with the imminent change of hands of Amil’s plans. According to reports, the company’s accredited network has shrunk in recent months, without warning.

Change in the accredited network must be informed

Currently, Rede D’Or has 65 hospitals across the country. As the largest private hospital group in Brazil, Robba believes that the company will want to incorporate its hospitals into SulAmérica’s accredited network. However, he points out that the consumer cannot be harmed, either in terms of quality or breadth of service.

“For an operator to replace a hospital, it needs to notify the consumer 30 days in advance and put another equivalent in place”, he says. “If there are any patients hospitalized, the company must also guarantee coverage of the treatment in that hospital until he is definitively discharged”, he adds.

According to him, the rule is that there are no changes, but in practice there are situations that harm consumer rights. “What worries me is in relation to the accredited network, I hope that Rede D’Or does not discredit other hospitals to maintain only its own.”

Sought, the hospital group reiterated the excerpt from the statement released on Wednesday in which it says that the operations will remain independent.

Despite the concern, Robba considers it difficult for something similar to what happened with Amil’s clients to repeat itself. The acquisition, he says, is being made by the largest private hospital network in Brazil, which is economically solid.

Melissa Dietrich, from the Farah Kanda office, also considers that the maintenance of the accredited network is unknown. However, the lawyer believes that the acquisition may even be positive in this regard, if Rede D’Or offers a larger network for policyholders.

Procon worries about market concentration

Fernando Capez, executive director of Procon in São Paulo, considers the union of companies a way to reduce competition, with the possibility of cartel formation and price domination.

“Procon is concerned about the sale of Sulamérica to Rede D’Or. [Conselho Administrativo de Defesa Econômica] have not seen it, there will be a risk of market domination, both in the hospital sector and in the insurance sector”, he says.

“We are afraid that, in the future, there will be only the public health system and Rede D’Or, no longer the private system”, he adds.

In addition to the financial issue, the director says that a possible market concentration could jeopardize the maintenance of coverage and the accredited network.

“Having domination, this will allow you to set the conditions you want for the insured.”

What worries lawyer Melissa Dietrich are the recent acquisitions of health insurance companies. According to her, since the ANS went into operation, the number of operators has been decreasing.

“We begin to think about a market concentration of health plans. Each time it concentrates more, the beneficiary is harmed”, he says.

SulAmérica announced the purchase of Sompo in December

In December, the insurance company had announced the purchase of Sompo Saúde, for R$ 230 million. However, the company did not explain how the acquisition by Rede D’Or will affect these beneficiaries. According to her, only the signing of the deal with Sompo has been carried out so far.

The company does not detail the proportion of individual and family plans, but, according to last year’s financial report, they represent a small slice of the business: 11% of total revenues in the area of ​​health and dentistry come from these plans.

Procon charges transparency

The executive director of Procon recalls that the agency has already fined and processed all health plans, to have access to reimbursable expenses by operators in the previous year and be able to calculate the fair margin of adjustment. “Today it is done without transparency, so we don’t know what greed is and what is recomposition of contractual balance.”