Insurance Claim Denied in Brazil — How to Appeal (ANS and SUSEP Guide)
Your health or insurance claim was denied in Brazil. Here's how to use ANS, SUSEP, and Brazilian consumer law to appeal your denial and get your money back.
Brazil has strong consumer protection laws for insurance policyholders. If your health insurer (plano de saúde) or insurance company denied your claim in Brazil, you have multiple pathways to appeal — including regulatory complaints to ANS and SUSEP, which are free and highly effective.
Brazil's Insurance Regulatory Framework
ANS (Agência Nacional de Saúde Suplementar) regulates health insurance (planos de saúde) in Brazil. If your health plan (Amil, Bradesco Saúde, SulAmérica, Hapvida, NotreDame Intermédica, Unimed, etc.) denied a claim, ANS is your primary regulator.
SUSEP (Superintendência de Seguros Privados) regulates life insurance, property insurance, liability insurance, and private pension plans. Dental insurance (odontológico) falls under SUSEP.
PROCON and the Código de Defesa do Consumidor (CDC) — Brazilian Consumer Defense Code — also provide strong protections. Insurance policies are consumer contracts, and the CDC's protective provisions apply, including the principle that ambiguous clauses must be interpreted in favor of the consumer.
Your Rights Under Brazilian Law
ANS Resolution RN 566/2022 — establishes updated guidelines for coverage and appeal processes for health plans. Your health plan must:
- Issue written denial with the specific reason and the contract provision relied upon
- Offer an appeal (recurso) process internally
- Respond to ANS complaints within regulatory deadlines
ANS Resolution RN 465/2021 — governs coverage for procedures in the mandatory health plan coverage list (Rol de Procedimentos e Eventos em Saúde). If your procedure is on the Rol, denial is presumptively illegal unless an explicit exclusion applies.
Lei 9.656/98 (Health Plan Law) — the foundational statute for health insurance in Brazil. Article 10 defines mandatory coverage and prohibited exclusions.
Lei 10.406/2002 (Brazilian Civil Code) Art. 765 — requires good faith in insurance contracts.
How to File an ANS Complaint
Step 1: Internal appeal first. Before ANS, your health plan must have an internal appeals process. Submit your appeal in writing (and keep proof of delivery) with:
- Your complete medical records and test results
- Your doctor's letter explaining medical necessity
- The denial letter from your health plan
Step 2: File with ANS if the internal appeal fails.
Online: ans.gov.br → "Canal de Reclamações" Phone: 0800 701 9656 (free, available Monday–Friday) In person: ANS regional office
ClaimBack generates a professional appeal letter in 3 minutes — citing real insurance regulations for your country. Get your free analysis →
Your complaint should include:
- Health plan registration number (CNPJ and ANS registration)
- Description of the service or procedure denied
- Copies of the denial letter and your appeal
- Medical documentation
ANS deadline: ANS typically handles complaints within 5 business days and may order the health plan to provide coverage immediately while the investigation proceeds.
How to File a SUSEP Complaint (Non-Health Insurance)
For life, auto, property, or travel insurance denials:
Online: susep.gov.br → "Serviços → Reclamação" Phone: 0800 021 8484
PROCON and Consumer Courts (Juizado Especial)
PROCON (Consumer Protection Bureau) can mediate insurance disputes. File at your state's PROCON office — many have online portals.
Juizado Especial Cível (Small Claims Court): For claims up to 40 minimum wages (~R$ 52,000 in 2026), you can file in Juizado Especial without a lawyer. The process is fast (hearings within 30 days), free, and effective against insurers.
Superior Tribunal de Justiça (STJ) precedents: Brazilian courts consistently apply consumer protection principles in insurance disputes. The STJ has ruled that:
- Denial of procedures on the ANS Rol is illegal
- Insurers cannot exclude coverage for complications arising from covered procedures
- Coverage for "high complexity" treatments must follow evidence-based medicine
The ANS Rol de Procedimentos
Every health plan in Brazil must cover all procedures listed in ANS's mandatory coverage list (Rol de Procedimentos). This list is updated periodically and includes:
- Most surgical procedures
- Hospital admissions
- Diagnostic tests (imaging, laboratory)
- Mental health treatment (since 2023 amendments)
- Cancer treatments on the list
If your procedure is on the Rol and was denied, file an ANS complaint immediately — this is one of the easiest denials to win.
Fight Back With ClaimBack
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