A recent survey by the Brazilian Institute for Consumer Protection (Idec) showed that health plan operators were the leaders in complaints from Brazilian consumers in nine of the last ten years. Therefore, it is essential to know who to turn to when you have problems.
According to Idec, the main problems highlighted are doubts about contracts, lack of information and readjustments. The National Supplementary Health Agency (ANS), responsible for regulating the sector, states that the first contact for complaints should always be made through the operator’s “contact us” section. In each contact, it is important that the customer writes down the protocol number generated.
In case of refusal from the operator or lack of clarification, the second option is to seek the plan’s ombudsman. All operators must offer direct contact with their ombudsman. The list of telephone numbers, emails and addresses for in-person contact is available on the ANS website.
The next step if the problem persists is to contact ANS. In this case, it is necessary to have the protocol numbers registered with the operator. It is possible to contact the Agency by calling 0800 701 9656. There are also some centers for in-person assistance spread across the country. The addresses are at this link. Another alternative is the online system, available here. Access is via the gov.br account.
The ANS determines a period of five working days for operators to contact their customers in case of complaints of an assistance nature, that is, relating to care provided by the medical or dental network. This is the case, for example, of difficulty scheduling procedures or denial of care.
In the case of other demands that are not related to service, such as problems in contracts, adjustments and monthly fee amounts, operators have up to ten working days to provide feedback to the consumer, counting from contact with ANS.
After receiving the response, the consumer must respond to the Agency, which will contact them by email or telephone. If the consumer considers that the problem has been resolved, the demand is finalized. Otherwise, an internal sector of the ANS will analyze the case to decide what response should be given.
Editing: Thalita Pires
