Medical billing
Brazil — planos de saúde, the ANS rol de procedimentos and the consumer route
NationalBRDerived or secondary source
Brazil
- Rule id
- medical.br
- Version
- 1.0.0
- In force from
- June 3, 1998
- Last read against its sources
- August 5, 2026
- Countries bound
- Brazil
In plain language
What this regime says.
Private health plans must cover what the ANS list requires, and since Lei 14.454/2022 the list is a reference basis rather than an exhaustive limit. The ANS complaint route is free and fast.
Who is covered
Holders of Brazilian private health plans.
What you get
A reasoned written refusal, an ANS complaint with mandatory response deadlines, and consumer protection over the contract.
Where claims go wrong
- Accepting "it is not in the rol" as a complete answer. Since 2022 it is not.
- Not getting the refusal in writing before escalating.
Authority
Every citation,
with its pinpoint.
A claim that cites “EU law” gets filed. A claim that cites Article 7(1)(c) gets answered. These are the exact coordinates this entry rests on.
- Lei nº 9.656, de 3 de junho de 1998Lei dos Planos de Saúde (Brazil)URL verified 2026-08-05The regulation of private health plans, mandatory coverage and the limits on exclusions
- Lei nº 14.454, de 21 de setembro de 2022Lei 14.454/2022 (Brazil)URL verified 2026-08-05Amending Lei 9.656/1998 to provide that the ANS list of procedures is a reference basis rather than an exhaustive limit, and setting the conditions on which coverage outside the list must be provided
- Lei nº 8.078, de 11 de setembro de 1990 (Código de Defesa do Consumidor)Código de Defesa do Consumidor (Brazil)URL verified 2026-08-05Consumer protection provisions applied to health plan contracts, including the interpretation of ambiguous terms against the supplier
Sources
Where a figure is indexed, converted or published by a regulator rather than fixed in the instrument, the provenance is recorded separately. Anything marked as a modelled estimate is exactly that — a model, not a statutory number.
- Notificação de Intermediação Preliminar — the ANS complaint route against a health planAgência Nacional de Saúde Suplementarretrieved 2026-08-05
What it imposes
Clocks, defences and the ladder.
A rule module builds these while it evaluates, because a limitation period depends on which forum is open to you. What follows is the structure this regime produces — deliberately with no dates and no figures, because those belong to your facts rather than to the law.
What it entitles you to, beyond money
- Coverage of treatment outside the rol where the statutory conditions are metLei 14.454/2022. A refusal resting solely on absence from the list is incomplete.
- The ANS preliminary intermediation complaintFree, fast and effective. The plan is required to respond within a short deadline.
- Consumer protection over the plan contractThe Código de Defesa do Consumidor applies to health plan contracts, including the construction of ambiguous exclusions against the plan.
Where to take it next
- Written demand to the plan for a reasoned refusalAsk for the refusal in writing with its contractual and regulatory basis. That document is what every later step turns on.Claim directtypically 10 days
- ANS — Notificação de Intermediação PreliminarFree complaint route with short mandatory response deadlines for the plan.Regulatortypically 30 daysofficial page
- ProconState consumer protection bodies take complaints about health plan contracts under the CDC.Regulatortypically 60 days
- Juizado Especial CívelBinding on themSmall claims court, usable without a lawyer below the statutory threshold, and the forum in which most coverage refusals are ultimately decided. Urgent injunctive relief is available where treatment cannot wait.Courttypically 180 days
Documents
What this regime can produce.
Every one of these is a document you send yourself, in your own name. Duesday never writes to anybody on your behalf and is never anyone’s agent.
The same claim type elsewhere
EU cross-border healthcare — Directive 2011/24/EU reimbursement, the EHIC and the S2EUSupranational — 27 countriesDirective 2011/24/EU, Arts. 6, 7 and 8Confidence: highFrance — dépassements d'honoraires, secteur 1 and 2, and the OPTAMFRNational — FranceCode de la santé publique, art. R. 4127-53Confidence: mediumGermany — the GOÄ and GOZ private billing schedules and their multiplier limitsDENational — GermanyGebührenordnung für Ärzte (GOÄ), §§ 2, 5 and 12Confidence: mediumIreland — public hospital charges, medical cards and the HSE complaints routeIENational — IrelandHealth Act 1970 (as amended)Confidence: lowItaly — Servizio Sanitario Nazionale, the ticket and the URP routeITNational — ItalyLegge 23 dicembre 1978, n. 833Confidence: lowNetherlands — NZa tariffs, the eigen risico and the SKGZ dispute routeNLNational — NetherlandsWet marktordening gezondheidszorg (Wmg), art. 35Confidence: mediumSpain — Sistema Nacional de Salud coverage and the right to economic informationESNational — SpainLey 41/2002, de autonomía del pacienteConfidence: lowUnited Kingdom — NHS charging, overseas visitor invoices and private healthcareGBNational — United KingdomNational Health Service Act 2006, s. 1(4)Confidence: medium
Other rights in the same countries
Brasil — Sistema de Valores a Receber (SVR), Banco Central do BrasilBRNational — BrazilLei n° 14.973, de 16 de setembro de 2024Confidence: lowBrazil — ação civil pública and the CDC collective actionBRNational — BrazilLei nº 8.078/1990 (Código de Defesa do Consumidor), arts. 81-104Confidence: mediumBrazil — caução locatícia (Lei nº 8.245/1991, arts. 37–38)BRNational — BrazilLei nº 8.245/1991, art. 37Confidence: highBrazil — CDC price information and repetition of the undue chargeBRNational — BrazilLei nº 8.078/1990 (Código de Defesa do Consumidor), arts. 6, 31 and 42Confidence: mediumBrazil — Código de Defesa do Consumidor (right of regret and double refund of undue charges)BRNational — BrazilCódigo de Defesa do Consumidor, art. 49Confidence: mediumBrazil — Código de Defesa do Consumidor art. 49 and the e-commerce decreeBRNational — BrazilCódigo de Defesa do Consumidor, Lei nº 8.078/1990, art. 49Confidence: highBrazil — CorreiosBRNational — BrazilCódigo de Defesa do Consumidor, Lei nº 8.078/1990, and the Correios service regulationsConfidence: lowBrazil — Operator conditions of carriage with the Código de Defesa do ConsumidorBRNational — BrazilCódigo de Defesa do Consumidor, Lei nº 8.078/1990Confidence: low
Does this one reach your facts?
The engine runs every regime that could apply at once and reconciles them, rather than making you guess which page to read.
Not a law firm. Not legal advice. You send it yourself. This page describes a law; it is not advice about your situation and no outcome is promised.