New database considers complaints unresolved; 120 operators were in the worst performance of the 4th quarter
(National Agency for Supplementary Health) classified 540 health plans operators in the zero range, which represents the better performance na, while 120 companies were in track 3, the worse performance of the sector.
The agency The results of the 4th quarter of 2024 this Monday (7.abr.2025). Monitoring now uses an expanded database, which considers consumer complaints about negative coverage or non -compliance with maximum service deadlines.
Despite the results, no operator will have the plans suspended, as the ANS interrupted the cycles of the 2nd and 3rd trimester of 2024 for adjustments in the indicator. The suspension of sales occurs when a carrier remains in the Range 3 by 2 consecutive quarters.
How Monitoring Works
Monitoring the assurance of care is the main instrument of ANS to evaluate the access of beneficiaries to the contracted coverage. The analysis is based on complaints about coverage or delays in consultations, exams, therapies and surgeries.
Operators are classified into performance ranges, from 0 (better) to 3 (worse), according to the proportion of complaints regarding the beneficiaries.
Here are the numbers by track:
- zero range (best performance): 540 operators:
- Range 1: 170 operators;
- Range 2: 51 operators;
- Range 3 (worse performance): 120 operators.
What changed
The new calculation was approved at the 60th Meeting of the ANS Collegiate Board, held on July 1, 2024.
Now, the indicator considers 50% of the total demands informed as not resolved by the beneficiaries in the period for each cycle as a base of the numerator’s calculation.
Previously, the analysis was made based on the care demands analyzed and classified by the Inspection Board.
According to director of product standards and qualification, Alexandre Fioranelli, it will be possible “Evaluating more accurately which operators have problems, identify risks to beneficiaries assistance and ensure consumer protection in cases of irregularities.”
“We no longer depend on manual analysis of care demands and we maintain the use of complaints from beneficiaries as evidence of infringement in service -related issues.”said Fioranelli.
The denominator follows as the average beneficiaries by operator during the analyzed period.
