Complaints against Prevent Senior at ANS rose 67% in the 1st year of the pandemic

Health operator Prevent Senior had a 67% increase in complaints registered by beneficiaries at the ANS (National Supplementary Health Agency) in the comparison between 2019 and 2020, the first year of the Covid-19 pandemic.

This year, until the beginning of October, 1,172 complaints were added, almost the total accumulated in the entire previous year (1,484).

There was also an increase in relation to the opening of administrative proceedings with evidence of infringement attributed to the operator. Between 2019 and 2020, this item increased by 36%.

Complaints are called by the technical name NIP (Preliminary Investigation Notification), which can be classified between assistance, related to coverage restrictions, and non-assistance, which involves other situations.

Between January 2019 and the first week of October 2021, the total number of complaints related to coverage of medical procedures was 91%, according to official data.

The numbers were obtained by the lawyer specializing in health insurance Marcus Patullo via LAI (Access to Information Law). He says that he decided to investigate Prevent Senior’s reputation at ANS after the scandal that led the operator to the Senate CPI.

“Last year, there was a drop in elective care because of the pandemic. So what is this increase in complaints about? It is probably related to the care provided to Covid’s patients,” says the lawyer.

For Patullo, the rise in complaints should not have gone unnoticed by the ANS, which could have taken steps in an attempt to contain the crisis that erupted in the health care provider. “The numbers should, at the very least, have turned the yellow light on at ANS”, he says.

In testimony to the Senate CPI at the beginning of October, the director-president of the ANS, Paulo Roberto Rebello Filho, stated that he became aware of the problems with Prevent Senior only after the beginning of parliamentary investigations.

The statement was criticized by congressmen, who pointed out the regulatory agency’s serious omission in relation to the operator’s conduct.

Congressmen based the accusations in a dossier prepared by doctors who point out that the network’s hospitals were used as laboratories for early treatment against Covid-19, with drugs without proven efficacy to fight the disease.

After evaluating that the accusations made to the CPI contained “indications of operational failures”, Rebello Filho announced the appointment of an ANS director to monitor the treatment given to beneficiaries from within the operator.

When contacted, Prevent Senior stated that the comparison of data for 2019 and 2020 is not adequate because it relates a period without a pandemic to “another one in which there were drastic social and epidemiological changes resulting from the coronavirus”. “It is natural that, in times of greater tension and growing demand, complaints increase,” said the operator, who said he is working to resolve all complaints.

In a statement, the ANS stated that it monitors the supplementary health sector and acts to investigate registered complaints. “The percentage of resolution of claims by Prevent Senior was above 96% in the last three years”, informed the agency.

The regulatory agency also informed that the total number of complaints registered in the agency’s channels increased by 13% between 2019 and 2020.

Currently, the operator is the target of the CPI of the City Council in São Paulo, in addition to representations at Cremesp (Regional Council of Medicine of São Paulo).

Due to the distribution of the so-called “Covid kit” drugs, without scientific proof of effectiveness to treat the disease, the company signed a TAC (Term of Adjustment of Conduct) with the Public Ministry in which it undertakes to no longer distribute or prescribe medicines.