Health plan operators cancel contracts for families who have them One or more members with autism spectrum disorder (ASD). Decisions are unilateral, communicated to customers via email or through a message on the company’s app, and made without any justification, as evidenced by more than 190 complaints sent so far this week to Alesp (Sao Paulo State Legislative Assembly).
The complaints were in fact directed at state deputy Andrea Werner (PSB), chair of the association’s committee for the defense of people with disabilities, and herself an atypical mother, because her 14-year-old son, Theo, is autistic.
“Most complaints come from families of people with autism, whose children are undergoing treatment, with treatments that enable them to develop and socialize. We receive, albeit on a smaller scale, complaints about breach of contract with cancer patients undergoing treatment, both children and adults, and cases of people Those with endometriosis, depression, anxiety, etc., who also have autistic children,” says the MP, who is a journalist and activist for the rights of people with disabilities.
It claims that complaints about contract cancellations involve at least six health plan operators. “Most of the cases, 90%, are against Unimed Nacional, and 5% cited Bradesco Side. The rest are scattered between Blena Side, São Cristóvão, Notre Dame and Sol América,” he says.
To plan how to help those seeking a solution to these cases, the Committee for the Advocacy of Persons with Disabilities met, for the first time since members were elected, on Tuesday (16). This group debuted in the current legislature Alesp.
One of the first activities that the group should propose is to have a conversation with representatives of entities such as Abramge (Brazilian Association of Health Plans) and Fenasaúde (National Federation of Complementary Health). We want them to explain to us the reason for these unilateral cuts.”
A public hearing on the matter, with the participation of a human rights lawyer, is scheduled for the 25th at 10 am, as the deputy informed via her social networks:
At a meeting on Monday (15th), the Department of Consumer Defense Justice informed Andrea that contract revocation is already under investigation. To cooperate with the investigation, the attorney’s office has undertaken to refer complaints to the responsible attorney general, segregated according to the health plan companies involved.
What do the companies say
Wanted by Report from R7FenaSaúde sent the following note:
Unilateral termination of group HMO contracts is one of the possibilities set forth in the contract and in the sectoral rules defined by the Health Services Agency. [Agência Nacional de Saúde Suplementar]. When they occur, rescues are informed to recipients in advance and are never conducted in a discretionary or discriminatory manner or with the intent of restricting people’s access to treatments. The main objective of our operators is to always keep the beneficiaries of good service, to take advantage of management procedures, to control costs, to combat fraud, abuse and waste, to encourage the conscious use of plans and to advocate for the appropriate integration of new technologies.”
As Unimed Nacional clarified in a statement, however, without explaining why it only mentioned business plans: “The unilateral termination of collective commercial contracts is foreseen and regulated by the ANS (National Agency for Complementary Health). The companies are notified in advance of this termination of the contractors. It covers all associated beneficiaries contract and not just specific persons.The purpose of termination is solely to maintain balance in the management of health plans.
Via email, Bradesco Saúde says it will “monitor FenaSaúde’s position in relation to the agenda. It represents 14 groups of private healthcare plans and insurance operators, Bradesco Saúde among them.”
On a note, Sul América responded that it “does not cancel contracts and/or exclude beneficiaries with physical or mental disabilities. The company sells group and commercial plans, and cancellations generally occur by decision of the contractor. We affirm a commitment to continuous improvement of the quality of SulAmérica’s services and products, and it is our view that It is necessary to listen to and understand the demands of the beneficiaries in order to always provide solutions and improve.”
ANS and companies Plena Saúde, São Cristóvão and Notre Dame have also been contacted, but have not yet responded.
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