Camila Vieira Guimarães
Lawyer at Marcos Martins Advogados
In April 2020, the National Supplementary Health Agency (ANS) calculated that there were more than 47 million beneficiaries of healthcare plans throughout Brazil.
The dizzying rise in the spread of the new coronavirus – Covid-19 – has worsened exponentially, with new cases of contamination and deaths every day, placing intense demands on private health insurance providers.
Faced with an unprecedented scenario, with proportions never before experienced, there are daily conflicts between denials by private health insurance companies, blaming possible liability on public health.
It is therefore important to highlight the measures already regulated by the ANS, which private health insurance companies must comply with:
- Inclusion of the test to detect the new Coronavirus (Covid-19) in the list of mandatory procedures for health insurance beneficiaries;
- Although there is no specific treatment, health plans already
- have mandatory coverage for the procedures used to treat the consequences caused by the Coronavirus (Covid-19), namely consultations, hospitalizations and exams;
- Extension of the maximum deadlines for non-urgent procedures, in order to avoid overloading the health system and increasing the exposure of beneficiaries to the risk of contamination. As for urgent procedures and treatments that cannot be interrupted, such as prenatal care, post-surgery, cancer and psychiatric treatments, the deadlines have not changed.
As for the denials of care by health insurance companies on the grounds of a contractual waiting period, although the ANS has yet to rule on the matter, we have already identified court rulings that oblige private health insurance companies to waive the waiting period and provide immediate emergency care for their beneficiaries due to coronavirus contamination. These decisions were based on the Health Insurance Law (Law No. 9.656/98), which states that in the event of an emergency that poses an immediate risk to life or irreparable harm to the patient, coverage by the accredited network is mandatory[1].
In the event of any problems with service, it is recommended that the beneficiary contact the operator directly through the service channels provided, preferably via telephone and the internet. If unsuccessful, the Marcos Martins Law Firm reaffirms its commitment as a legitimate partner in proposing effective solutions for its clients and other interested parties who need guidance in dealing with this uncertain scenario, including with regard to denials of services by private health insurance providers to beneficiaries.
Questions? Talk to our lawyers and get advice.
[1] BRAZIL. Law No. 9.656, of June 3, 1998. Provides for private health care plans and insurance. Federal Official Gazette, June 4, 1998:
Art. 35-C. It is compulsory to cover care in the following cases
I – emergencies, defined as those involving an immediate risk to the patient’s life or irreparable injury, characterized in a statement by the attending physician;
