Public Health

Procon São Paulo disclose health plans with the highest complaint

The records had slight increase compared to the same period in 2012, from 6100 to 6500

Foto: Secretaria de Justiça de São Paulo
Paul Arthur Goes, CEO of Procon-SP
Paul Arthur Goes, CEO of Procon-SP

The delay in getting the authorization for surgery, laboratory tests and even rejection of these procedures are among the main complaints against companies health plans received by Procon São Paulo. This is shown by the survey made by this body, linked to the Department of Justice and Consumer Citizenship of the State of São Paulo, in the ten companies claimed more.

In the list, the Amil Group, formed by the health insurance Amil, Amico, Medial and Dix, ranks first, followed by Qualicorp Benefits Administration; Green Line; Unimed Paulistana; South America; Intermedica; Somel; Universal; Bradesco and Golden Cross.

According to Procon, of all complaints filed in the first half, the sector was sixth in the ranking. The records had slight increase compared to the same period in 2012, from 6100 to 6500.

The most common complaints regarding health care coverage is the delay in authorizing procedures, negative total or partial coverage or reimbursement based on the List of Procedures and Medical Events published by the National Health Agency (ANS) in contractual exclusion or unilateral interpretations as to claim preeexistentes diseases, cites a statement by Procon.

Already in reference to the services network, the problems highlighted by the customers are the difficulty in scheduling appointments or examinations and noncompliance with deadlines to meet either in consultations, tests or surgery, as well as changes in the provider network and the imposition of restrictions on the right of choice.

The Board also receives reports from policyholders who had contracts canceled without proper notification, error in the value of the tuition charged, delays in sending these payment slips or wallets and medical guide; abuse in fines for payments arrears and charges made after termination.

"After 15 years of the regulatory framework for the sector, with the enactment of Law No. 9.656/98, continue the serious problems of access to medical care and application of high levels of adjustment, with particular vulnerability of consumers in group plans, not have adequate protection legislation and the agency itself, "said the CEO of Procon-SP, Paul Arthur Goes in a statement.