Amell's 5.4 million health plan beneficiaries cannot be affected by the company's sale and are protected by law to maintain the level of quality, quantity and location of services provided, according to the Procon Foundation in São Paulo.
Last week, the country's fourth-largest health plan operator, Amil, which belongs to United Health Group (UHG), was sold for R$11 billion to the businessman. Jose Serebiri FilhoJunior, who founded Qualicorp.
“In cases of partial or total portfolio acquisition, the supplier absorbing the health plan company must maintain the same terms of the plan and the signed contract,” says Robson Campos, legal director of Fundação Procon de São Paulo.
He points out that health plan clients are covered by three pieces of legislation. First, in the general principles of consumer protection law that define rights and duties in the consumer relationship. Then under Law 9656/98 regarding health plans. Finally, Resolution No. 112 of 2005 of the National Health Agency.
According to the Legal Director, these laws stipulate maintaining the quality of services provided, the number of hospitals and certified professionals, as well as the location of health institutions.
“Hospital substitution is permitted and provided for by law, but the consumer must be individually informed of the change 30 days prior to the change.”
Long treatments for serious diseases
If a beneficiary is undergoing long-term treatment for a serious illness, such as cancer, for example, the law provides that the patient continue treatment at the same hospital, even if excluded by the plan, only if the beneficiary is hospitalized,” notes Campos.
If the treatment is long, but does not involve hospitalization, and hospitalization is ruled out in the meantime, the Procon Director recommends that the beneficiary go to court, given the critical nature of the problem.
“The consumer has rights, and cannot be harmed by the negotiation issue.” Recently, health plans have been one of the leading sectors in consumer complaints received by Procon-SP.
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