A 5-Year-Old Girl Is Dying in Brazil Because Insurance Refuses to Pay for US$ 10,000 Surgery

Hapvida Leandra Silva Cerqueira is  only 5 years old but is already dying. She has a very serious cardiac problem. She suffers from interventricular communication. According to the site heart-vessel.com, it corresponds to the abnormal passage of blood between the two ventricles (generally from the left ventricle toward the right ventricle).

It is a malformation occurring during the making of the heart during pregnancy (congenital disease) and generally disappears during the first years of life. Sometimes, surgery is necessary to close this communication.

Unfortunately this is the Leandra’s case, a beautiful child from Salvador, Bahia. Leandra should be lucky. She has the plano de saúde, health insurance, unlike the vast majority of the babies in Bahia. However she is not. Because her insurance company refuses to pay for her surgery.
 
Hapvida, the insurance company, refused to pay for the treatment several times. It was condemned by the judge Laura Scalldaferri to offer treatment or pay a daily penalty of 1.000 reais back on September 8, 2011.

Hapvida refused to comply even after October, 15, when the judge increased the penalty to 5000 reais per day. Luiz Gonzaga Vieira, Leandra’s lawyer, will now ask for the imprisonment of the directors of the insurance company.

The surgery should be done at the Santa Isabel hospital, in Salvador, Bahia state, according to the judge’s determination. The total cost of the procedure as charged by the hospital would be 16,754.99 reais (US$ 9926), says Vieira.

Hapvida is a very dynamic company. It is already the 4th largest health insurance company nationwide and the first one in the Northeast of Brazil. Its goal is to earn 1 billion reais (US$ 592 million) by 2012. It started in Fortaleza, capital of the state of Ceará, after the creation of a local hospital. Its clients are in the so-called C and D classes. It sells cheap health insurance plans.

Jorge Fontoura Pinheiro Koren de Lima, President of  Hapvida Sistema de Saúde, the holding company which controls the family business, was named as one of the most dynamic entrepreneurs in Brazil by the Isto É Dinheiro magazine.

Hapvida is growing at an explosive rate: in 2004 the company’s earning was 193 million reais, which grew up to 631 million reais in 2009 and to about 760 million in 2010. Its aggressive strategy to reach the underserved low-income classes has worked. The result is Hapvida growth rate, beyond any expectation.

However together with that there were several problems. Refusal of treatment to patients has become more and more common. Leandra’s case is far from unique. In the state of Ceará Hapvida was condemned to pay more than 12,000 reais after refusing to give treatment to a public officer who needed a prosthesis after a serious accident.

Just a few days ago, the health insurance company was once again condemned for refusing to give treatment for infertility. .

Maybe the company is a mirror case for Brazil, which is growing fast and strongly. Everybody can see it. However this growth is not being accompanied by other things, like respect for the rights of consumers and clients and stronger regulations to defend the public from piratical business strategies.

This is not happening in Brazil, leaving Brazilian clients without any protection against this law of Far West.

Leandra will die if nothing happens and Hapvida continues refusing to give her treatment. It might be a matter of days. Nobody seems to be doing anything. Where are the politicians, where are the laws to defend the unprotected weak parts of the society?

There is no mercy for a dying child in Bahia, Brazil

Max Bono is an investigative journalist traveling in Brazil.  You can contact him at researchinrio@yahoo.com.

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