Health operator Prevent Senior excluded 15 hospitals from its accredited network between January and March this year and saw the number of complaints soar, according to the ANS (National Supplementary Health Agency).
In the fear period of 2021, no hospital was excluded by the operator – there was only the replacement of one location.
Human resources manager Mauro Tadeu Augusto, 56, recently discovered that Prevent Senior, a plan he has paid for for three years, does not offer consultations with an orthopedist in the north of São Paulo, where he lives.
“I live 5 minutes from two Prevent units and I have to go to Santo Amaro [zona sul] or Analia Franco [zona norte] to be cared for”, he says about distant neighborhoods from his home. “Can you imagine the elderly who can’t pay for this displacement?”
Beneficiaries registered 662 complaints with the ANS between January and March this year, more than double the number calculated in the same months in 2021, when there were 311 complaints.
The survey only considered the first week of March, so the first quarter of this year should see an even greater increase in complaints.
Current legislation requires companies to communicate to the regulatory agency only cases of disqualification of hospital establishments, but not of other providers, such as doctors and laboratories.
The ANS also clarifies that operators have the right to reduce the hospital network as long as the calls are absorbed by other hospitals and with the express authorization of the agency.
In a note, Prevent Senior stated that it is restructuring its network of partners and that “a good part” of the disqualifications came from service providers, after the company disagreed with abusive readjustments of transfers. “The operator’s services and the medical care provided were not affected, despite possible occasional inconvenience”, informed the operator.
One of the disaccredited laboratory networks, the CDB (Diagnostic Center of Brazil), stated in a note that the decision to no longer serve the plan’s customers was Prevent Senior’s unilateral decision. “The laboratory continues with its doors open to customers through private service.”
Regarding the increase in the number of complaints from Prevent beneficiaries, ANS stated that the operator has been under a technical management system, a monitoring mechanism carried out by the body, since October 2021. “The agency reinforces that it is conducting investigations on the operator rigorously and carefully.”
According to ANS, the numbers of complaints refer to manifestations that have not yet been appreciated and, therefore, do not necessarily represent infractions by the operator. Complaints are automatically directed to health operators, who have five to ten business days to send a response to the beneficiary.
Prevent Senior stated that the complaints to ANS are largely due to non-assistance complaints, such as delays in collection slips. This was due to the implementation of a new financial management system. “Prevent has resolution rates that reach almost 100% of complaints, and is working to reduce them.”
According to the lawyer specializing in the rights of users of health plans Marcos Patullo, the legislation allows the disqualification of the network of partners as long as companies replace it with an equivalent option. “This is usually quite controversial because the criterion of equivalent, in these cases, is subjective”, he says.
For example, the health care provider is not obligated to replace a doctor or laboratory in the same neighborhood or region as the non-accredited provider, according to the lawyer.
According to the company, in the case of the beneficiary who complained about the lack of orthopedists in the network, consultations were offered in units within the period recommended by the contract and legislation. “Due to the fact that the offices are not close to the beneficiary’s residence, they were refused by the patient”, he informed.
In a note, the ANS stated that a survey is underway on providers discredited by Prevent Senior “to verify that the operator has complied with all regulatory standards”.
Health operators are required to inform changes in the care network up to 30 days in advance, according to the regulatory agency. If the rule is not followed, a fine of BRL 30,000 to BRL 50,000 is applied. The values can increase up to 20 times if the infraction produces effects of a collective nature.
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