Private health insurance coverage-related lawsuits.

Authors :: Afonso ABP
Menegueti MG
Araújo TR
Chaves LDP
Laus AM
Source :: Revista brasileira de enfermagem [Rev Bras Enferm] 2020 Apr 09; Vol. 73 (3), pp. e20180748. Date of Electronic Publication: 2020 Apr 09 (Print Publication: 2020).
Publication Year :: 2020
Abstract: Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators.<br />Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015.<br />Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment.<br />Conclusions: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.