Unimed do Brasil is the Unimed brand manager at the national level. She was enrolled as an employee of a health plan, but she did not act as such. Therefore, it is not clear whether Unimed do Brasil will practically take over the operation of the Ferj portfolio or whether it will hand over management to another Unimed company in the system.
What will the transformation be like?
According to ANS, the agreement is risk-sharing, and stipulates that Unimed do Brasil will retain 90% of the revenue from users’ monthly fees. With the amount, the operator must administer assistance to consumers. This includes, for example:
- Relationship with service providers, such as hospitals and accredited laboratories;
- Transferring payments to physician cooperatives, which remain linked to Unimed-Rio (Read more below); and
- Paying refunds, among other things.
The management of the network’s units, such as the emergency rooms in Barra da Tijuca, Copacabana and Mayer, and the Unimed Hospital, also in Barra, remains unknown. The hospital, one of the main units of medium and high complexity available to operator users, is owned by Unimed-Rio, but leased by Ferj. It has not been determined whether it will become under the control of Unimed do Brasil or not.
- Unimed-Rio and Ferj sign an agreement to settle a tax debt worth R$2 billion. Hospital da Barra is the guarantee
Unimed Ferj will continue to receive the remaining 10% of monthly fee revenues, the amounts of which must be used to repay debts incurred by November 30.
Analysts view this arrangement as an alternative to avoid the radical path of liquidating the operator, which would cause inconvenience to thousands of plan users.
— Risk sharing is a way to maintain care for beneficiaries without the shock of removing the operator from the market and leaving many consumers helpless. In previous experiences, we saw beneficiaries facing many problems, such as difficulty in accessing other operators and failure to respect the portability of grace periods – recalls Rafael Ropa, health law specialist at Vilhena Silva, and lawyer Rafael Ropa.
Will the approved network change?
Robba also points out that although the agreement is an attempt to ensure assistance to users, contracts must be fulfilled, and ANS must “monitor and monitor so that user service is not compromised.”
According to Unimed Ferj, all current contractual terms remain in effect. In other words: According to the operator, there will be no changes to the approved network, coverage or value of health plans.
What do bills that expire at the beginning of December look like?
Unimed do Brasil has not responded if anything changes in next month’s batch. According to Verge, operational issues will remain the subject of discussions and adjustments between the operator and UNIMED do Brasil.
What about the cooperating doctors?
The change in portfolio management comes a year and a half after users were sent from the then Unimed-Rio to Unimed Ferj, which had previously not operated as an operator, but only as an entity representing Unimeds in Rio de Janeiro. The first consumer migration took place, in 2024, with the approval of ANS and other authorities, more than a decade after the financial crisis by Unimed-Rio.
However, the situation did not improve. Since then, problems have piled up. Collaborating physicians report delays in payments and begin refusing care to users. The professionals are linked to Unimed-Rio, which pays their fees from the vulva transfers. But the doctors did not receive any of them.
The total debt owed to doctors is unknown. It is not yet clear whether anything will change, in practical terms, for doctors who cooperate with the change in health plan management from VIRG to Unimed do Brasil. What is known, from the ANS statement, is that the payment of wages to professionals will start based on transfers from Unimed do Brasil. The arrears must be settled by UNIMED Faraj.
How is the service currently?
According to the Rio State Hospital Association (Aherj), Unimed Ferj’s debts with health units exceed R$2 billion.
– We did not hear (in the agreement). We don’t officially know who we’ll be handing the bills to. This arrangement makes no sense. Marcos Quintilla, the entity’s president, says that this 10% barely covers the cost of managing the relief, let alone paying its obligations.
In this scenario, approximately 370,000 users — the wallet has become 20% smaller since the migration — see the approved network decline. In February, Rede D’Or stopped accepting patients from the operator. In September, the emergency rooms of Pro-Cardiaco (Botafogo), Vitoria (Para), São Lucas (Copacabana) and Santa Lucia (Botafogo) hospitals also suspended coverage.
The situation became more sensitive with the departure of Oncoclinicas Hospital, which was serving about 12 thousand oncology patients from Unimed Ferj. Users were redirected to Espaço Cuidar Bem, the operator’s unit in Botafogo, but a large number of complaints were registered about the site.
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