Health insurance companies are facing a growing number of lawsuits, many of them arising from discrepancies in the billing of medical bills, denials of coverage and a lack of transparency in the provision of services.
Last Friday (7) it was reported in the newspaper O Globo that "the number of lawsuits against health operators has doubled in the last 3 years, reaching 300,000 by 2024 alone". Faced with this scenario, the SAUDI System, which automates the entire process of medical bill audit has emerged as an innovative solution to minimize legal risks and improve the management of healthcare operators.
In order to help change this scenario quickly, the SAUDI Blog team has produced this exclusive article to explain how the SAUDI System can help to reduce lawsuits, ensuring greater efficiency, regulatory compliance and transparency in the operations of health insurance companies.
What is the SAUDI System?
SAUDI is an automatic medical bill management and auditing platform used by healthcare operators to optimize expense control and ensure compliance with the regulations of the National Supplementary Health Agency (ANS). The tool can be optimized with artificial intelligence and already has automation to analyze medical bills, validate charges and identify inconsistencies before they become legal problems.
Main causes of lawsuits against health operators
Health insurance companies are often the targets of lawsuits brought by beneficiaries, service providers and regulatory bodies. The main causes of these lawsuits include:
1. Denial of cover - When the operator denies a medical procedure on the grounds of lack of contractual cover.
2. Undue medical disallowances - Refusal to pay service providers for procedures due to billing errors or inconsistencies.
3. Collection of undue amounts - Disputes by beneficiaries regarding excessive charges or charges not provided for in the contract.
4. Lack of transparency - Difficulty for customers to understand the rules of coverage, leading to disputes and complaints.
5. Non-compliance with ANS deadlines - Delays in the release of procedures or reimbursement of medical expenses.
Faced with these difficulties, the use of an automated and intelligent system, such as SAUDI, can be a great ally in reducing litigation.
How does SAUDI help reduce lawsuits?
1. Automation in Medical Bill Auditing
One of SAUDI's main functionalities is the automatic audit of medical billsThis ensures that all charges are verified before payment. This significantly reduces the risks of undue disallowances and incorrect charges, two of the main factors that lead to lawsuits.
2. Compliance with ANS Standards
The tool allows operators to strictly follow the guidelines established by the ANS, avoiding fines and sanctions that could lead to legal action. The system automatically updates its rules as new regulations come into force, ensuring that the operator is always in compliance.
3. Reduction of human error
Checking medical bills manually is subject to human error, which can result in unjustified disallowances and incorrect payments. With SAUDI, the process becomes more precise and efficient, minimizing errors that can lead to legal disputes.
4. Greater transparency and legal certainty
The platform allows for the storage and detailed tracking of all audits carried out, providing transparency and traceability of information. This is essential for the operator to be able to present concrete justifications in the event of legal challenges, reducing the risk of convictions.
5. Rapid conflict resolution
By automatically detecting inconsistencies and offering solutions in real time, SAUDI reduces the operator's response time to complaints. Many disputes can be resolved administratively, without the need for legal action.
6. Improved Customer Service
By automating and improving process management, the operator can provide more agile and efficient service to beneficiaries. A clearer and more transparent service reduces customer dissatisfaction and the number of lawsuits for denial of coverage or undue billing. To this end, we offer intelligent modules such as Beneficiary APP fully optimizable, authorization module It is medical monitoring.
7. Intelligent Monitoring and Reporting
SAUDI generates detailed reports on billing patterns, allowing operators to identify possible problems before they result in lawsuits. The tool's predictive analysis can help create preventive strategies, reducing future risks.
Invest in shielding your health insurance company
Judicialization of supplementary healthcare is a growing problem, and operators need to invest in technologies that guarantee greater efficiency, compliance and transparency. The SAUDI System is a robust solution for the automatic auditing of medical bills, contributing directly to the reduction of lawsuits.
By automating processes, minimizing errors and improving relations with beneficiaries and service providers, SAUDI helps operators to act more safely and in compliance with ANS regulations.
Investing in this technology not only reduces operating costs and legal risks, but also strengthens the operator's credibility and reputation in the market. Schedule a demonstration of SAUDI now and see how Brazil's most awarded medical auditing system will BLIND your operator of health plans and provide significant results in the control and reduction of costs, disallowances, fraud, as well as in the 3 FIRST months of use!
