As of March 19, 2014, the Brazilian National Supplementary
Agency (Agência Nacional de Saúde Suplementar
– ANS) has officially started to mediate conflicts unrelated
to assistance matters arising out of contracts between consumers
and healthcare carriers.
Such mediation role is not entirely new to ANS; the agency has
been mediating conflicts since 2010, but up until last March 19 it
dealt only with assistance-related disputes.
What disputes ANS deems to be assistance and non-assistance in
nature? The distinction is not always obvious and there is no
clear-cut line between both categories. Typically,
assistance-related matters include complaints concerning coverage
offering and medical care, such as failure by carriers to schedule
appointments and medical proceedings within the minimum established
time frames, denial of coverage of medical proceedings, denials and
delays by carriers to reimburse insureds, etc.
