The head of Brazil's private health insurance regulator, the ANS, said he has advised friends and relatives to take their insurers to court when treatment claims are denied. Wadih Damous made the remarks on September 8 in Brasília, at an event with health industry executives and representatives of presidential campaigns, according to the Painel column of the newspaper Folha de S.Paulo.
"I will confess. Sometimes acquaintances, friends and family come to me. I tell them: go to court," Folha quoted Damous as saying.
The meeting, titled "A Saúde do Brasil em 2030: Onde Vamos Estar?" (The Health of Brazil in 2030: Where Will We Be?), ran from 8 a.m. at the B Hotel in the capital and was organized by the Amado Mundo channel with the Instituto Consenso, according to the trade site Saúde Insider. Health Minister Alexandre Padilha attended alongside Damous, and representatives of the main presidential campaigns presented proposals for the SUS, Brazil's free public health system, for private insurance, drug coverage and financing, weeks before the October election.
The statement follows the position Damous laid out on August 28 at a seminar run by the FGV university in Rio de Janeiro. Quoted by Saúde Insider, he said the agency "failed" as a regulator, that every lawsuit against a plan is a "defeat" for the ANS and that old regulatory gaps persist on issues such as refunds and co-payments. He called for cooperation among insurers, consumer protection groups, prosecutors and public defenders, and pressed Congress for stronger legal tools, citing Bill 7.419, which would update the 1998 health plan law and has been pending for 20 years.
What the data show
Figures from the CNJ, the council that oversees Brazil's courts, show the scale of the problem, according to a Saúde Insider survey. Courts received 704,800 new health lawsuits in 2025, covering the public system and private plans together. Suits against insurers rose from 228,640 in 2023 to 341,763 in 2025, up 49.5%. The trend held this year: from January to May, 154,885 new cases involved private plans, 20% more than in the same period of 2025, while the number of plan users grew only 1.8% between December 2024 and December 2025. Damous put the country's total of plan users at 53.1 million.
In a sample of 1,992 cases reviewed by the CNJ's Atalaia tool, 69.4% of the demands involved access to medicines or treatments, and half of those (50.2%) concerned technologies outside the ANS list of mandatory procedures, known as the Rol. The sample is a snapshot, not a full count. The industry disputes part of the litigation. Renato Casarotti, institutional relations vice president of insurer Amil, split lawsuits into "legitimate" and "predatory" categories and cited an agreement with the Rio de Janeiro public defenders' office, in force since July 2025, that settles 70% to 80% of demands out of court.
What to do after a denial
A customer who gets a refusal has options before and beyond a lawsuit: ask the insurer for the denial in writing, file a complaint through the ANS service channels and contact the public defenders' office, which is free of charge and, judging by the Rio agreement, settles most cases without a judge. Keeping test results, prescriptions and the insurer's written response shortens whichever path is chosen.