Customers whose health plans have been transferred from the worker complain of lack of medical coverage

Agent customers whose individual plans have been transferred to another company in the group complain of service failures and exclusion of units. They say they have not been notified of the change.

Halfway through the appointment, the salesperson, Letícia Fantinati, discovered that she was no longer able to continue the treatment. She has an individual plan from Amil for 10 years, suffers from a serious chronic illness, and faced a crisis in December 2021, when she was rejected at two hospitals in Sao Paulo.

“I already had my oximeter and pressure device on my arm, and I handed the documents to the nurse. When she looked at my document, she started tearing up the devices saying, ‘No, no…Your plan has been discredited.’ We will not respond to you. I’m still without treatment, because I don’t have a hospital to go to,” Leticia says.

Attorney Ann Bernadette Rabello has been unable to obtain care for an 83-year-old mother with Covid symptoms.

“My mother woke up with a fever, and at 6:30 am the teleconsultation came in. We were in a line of 3,600 people. At 12:08 the next morning, we simply broke up. When the time came, the app didn’t work,” says Ann Bernadette Rabello. .

After more than 20 years of paying for the plan, she would not have been entitled to get a Covid test on time and in the city she lives in, in the Rio metropolitan area.

“PCR can be done by Amil only after 15 days. We had to cross two cities to the capital, more than 35 kilometers away for a test,” says Ann.

In 2021 alone, it was governor From São Paulo has already received 285 complaints regarding a worker. The portfolio of nearly 340,000 beneficiaries of the operator’s individual and family plans began to be managed by another company of the group, APS..

“The successor of a worker does not respect contracts and is obliged to fulfill everything contained in the contracts concluded between the insured and the worker. To transfer a portfolio, in addition to permission from ANSThe insured’s agreement, because they are not obligated to contract with a company other than the company they chose when signing the contract. The insured was hurt and he was the last to know,” explains Fernando Capes, Director of governor from Sao Paulo.

“She received a call letter 15 days ago. It was a unilateral decision, so an agreement had to be reached on the relocation plan,” says Ann Bernadette.

Further negotiations are aimed at delivering APS to new consoles. Under the agreement, the group that will take over the company will have to receive a contribution of R$2.4 billion from Amel. But the National Agency for Complementary Health halted the transfer and questioned the group’s financial ability to ensure the operator’s operation..

The office above the garage of a property in the eastern district of São Paulo is the address given by Fiord Capital to the Trade Council. The company, an investment manager created three months ago, is part of the group interested in taking over the operator that acquired the portfolio of Amil policyholders.

Other business partners are health operator Seferin & Coelho, based in Porto Alegre, and Henning von Koss, who presents himself as the group’s CEO. Talk about the headquarters of the Fiord capital in São Paulo.

“This company is in the temporary process of defining the structures and headquarters, which will be in the Faria Lima area, and this movement should be clarified with this. However, you have another partner in the same proportion who has a beautiful building in the financial center of Porto Alegre, which was the headquarters of Seferin & Coelho Since 2015, in addition to hospitals and so on,” says Henning Von Koss.

The manager said he’s handing over the documents he requested ANS And that the group’s first goal, once it took over the operator, would be to solve service malfunctions.

“We are not running the business yet, but we are already very uncomfortable with what is happening. We are gaining a platform where you can grow, and it is stable, has a very strong network, has a very robust operation, has a secured contract, has the financial fundamentals in the current model, and is profitable in Its model and with investment in growth, therefore, what we call New Life and Oxygen, will be sustainable from now on. Our main goal is to be the largest operator of individual plans in the country,” says Henning Von Koss.

the Brazilian Institute for Consumer Protection You want ANS Review of the decision to transfer individual schemes from an operator to APSBecause of the failures in customer service, but also considering the odd business moves that followed the move, according to Idec.

the governor From São Paulo also criticizes transactions related to the health plan.

“the governor You will compete in transferring the portfolio of more than 300,000 policyholders from Agent to APS. Fernando Capes says APS is a small company that has yet to prove it has the financial backing to continue this portfolio.

The new group says it has the financial conditions to continue the operation.

“It is a company that was born with revenues of more or less than 3 billion R$, and it still has a positive margin. Our focus is on technology, structures, innovation, engagement, bringing the consumer closer. Therefore, there is a combination of time, resources, knowledge and management that allows it to develop safely for our clients” , says Henning Von Koss.

Emile stated that she had sent the documents requested by the National Agency for Complementary Health and that its priority was to ensure the assistance that the insured would expect.

the ANS confirmed that it had received documents for a possible transfer of plans to a new console; it summoned worker representatives to a meeting next week, where it will demand a plan to minimize problems in attending primary health care; And that the operator must maintain the same terms of contracts.