Unimed do Brasil is the manager of the Unimed brand at the national level. Although she was registered as a health insurance operator, she did not act as such. Therefore, it is not clear whether Unimed do Brasil will actually take over the management of the Ferj portfolio or whether it will be handed over to another Unimed in the system.
What will the transition look like?
According to ANS, the agreement is a risk sharing and stipulates that Unimed do Brasil will keep 90% of the revenue earned from users’ monthly fees. Depending on this amount, businesses will have to manage their support to consumers. This includes, for example:
- Relationships with healthcare providers such as accredited hospitals and laboratories.
- Remittance of payments to collaborating physicians, still connected to Unimed-Rio (Read more below);and
- Refund payments etc.
The management status of the network’s own departments, such as the emergency rooms in Barra da Tijuca, Copacabana and Mayer, and the Unimed hospital, also in Barra, remains unclear. The hospital is one of the main medium and high complexity units available to the operator’s users and is owned by Unimed-Rio but leased by Ferj. It has not yet been decided whether it will be placed under the control of the Brazilian Unified Medical Center.
- Unimed-Rio and Ferj signed an agreement to resolve tax debts of R$2 billion. Guaranteed by Hospital da Barra
The remaining 10% of the monthly fee income will continue to be received by Unimed Ferj and must be used to pay off debts incurred by November 30th.
Analysts see the deal as an alternative to avoid taking the drastic route of liquidating the company, which would inconvenience the plan’s thousands of users.
— Risk diversification is a way to maintain care for beneficiaries without causing the trauma of removing operators from the market and disabling some consumers. In our past experience, we have seen many problems for beneficiaries, such as difficulty in accessing other providers and disregard for the portability of grace periods, recalls Rafael Loba, a health law expert at Vilhena Silva.
Will the certified network change?
Roba also points out that while the contract is an attempt to guarantee support to users, the contract must be fulfilled and ANS “must continue to monitor the service to our users to ensure that it is not compromised.”
All current terms and conditions remain in effect, Unimed Ferj said. In other words, there will be no changes to the accredited network, insurance coverage or value of the health plan, according to the operator.
What kind of bills are due in early December?
Unimed do Brasil did not respond if there were any changes to next month’s payments. Felzi said operational issues will continue to be subject to discussion and coordination between the management company and the Brazilian universities.
What will happen to the cooperating doctors?
The portfolio management changes came a year and a half after moving users from the then Unimed-Rio to Unimed Ferj. Unimed Ferj previously functioned only as an organization representing Unimed in Rio de Janeiro, rather than as an operator. The first consumer migration in 2024, agreed by ANS and other authorities, comes after more than a decade of financial crisis caused by Unimed Rio.
However, the situation did not improve. Since then, problems have piled up. Collaborating physicians have reported delayed payments and have begun denying treatment to clients. The professionals are affiliated with Unimed-Rio, and their fees are paid from Ferj’s transfers. But the doctor had none of them.
The total amount owed to doctors is unknown. It is not yet clear whether anything will actually change for the doctors cooperating with the change in control of the health plan from Ferzi to the University of Brazil. What we know from the ANS statement is that payments to experts will begin to be made based on remittances from Unimed do Brasil. And that the arrears must be regularized by Unimed Felji.
What about your current service?
According to the Rio State Hospital Association (Aherji), Unimed Ferri’s debts to medical institutions exceed R$2 billion.
– Our opinions were not heard (in the agreement). Officially, we do not know who the bill will be sent to. This arrangement makes no sense. The 10% will barely cover Ferj’s administrative costs, let alone pay its debts, argues Marcus Quintella, the company’s president.
This scenario would reduce the certified network to approximately 370,000 users (portfolio has shrunk by 20% since the migration). Rededor stopped accepting patients from its operating company in February. In September, the emergency rooms of the Pro Cardiaco Hospital (Botafogo), Vitoria Hospital (Barja), San Lucas Hospital (Copacabana), and Santa Lucía Hospital (Botafogo), all of which belong to Rede Americas, also suspended coverage.
The situation became even more sensitive with the retirement of Oncoclínicas, which served Unimed Ferj’s approximately 12,000 oncology patients. Users were redirected to Espaço Cuidar Bem, a division of the operating company in Botafogo, where a large number of complaints were registered regarding the location.
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