• Fraud in the Health Plan | Get informed and be aware!

    DATE: 05/18/2023

    Published by: Horiens

    Fraud against the health plan

    Get informed and help prevent it!

    Yes, did you know that fraud costs health insurance companies in Brazil about BRL 28 billion per year, increasing the cost of medical procedures for patients by about one-third?

    In light of this situation, health insurance providers emphasize the importance of combating such practices that are often presented as “legitimate” and can confuse beneficiaries.

    Learn about the main frauds to avoid falling into them:

    Reimbursement without disbursement

    Reimbursements can only be requested by the beneficiary after personally paying for the service and providing proof of payment. The offer of supposed benefits, such as not having to pay for a consultation or procedure in exchange for the beneficiary’s access credentials to the plan’s portal or application, is an illegal conduct.

    Assisted or aided reimbursement

    Never give your access data to the application or health plan portal to a third party for any reimbursement. Requesting the beneficiary’s access data to the plan’s portal or application under the promise of “facilitating” reimbursement is an illegal practice, whose real objective is to have free rein to claim higher reimbursement amounts or include services that were not provided.

    Receipt Fractionation

    The reimbursement request amount should correspond to the full value of the consultation or procedure. Taking two receipts for a single visit or procedure to access a larger reimbursement is not allowed.

    False information on the receipt

    Describing a procedure other than what was performed to get reimbursement from the health plan is fraud. If you have questions about coverage, contact your health plan.

    Attention: register your reimbursement data in the health insurance app

    Keep your banking information updated in the plan’s app and always submit your reimbursement requests through it. This way, the payment is made through a bank deposit, directly into your account, increasing the security of the process and bringing more convenience to your daily life.

    The proper use of health insurance is a responsibility of all beneficiaries. In case of any doubts, please contact your health insurance provider.

    Share this information with your family and friends!

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