Brazil’s private health-care system lives with familiar distortions, but few are as visible as the new “glosa” dashboard published by ANS, the sector’s regulator. In it, SulAmérica — folded into Rede D’Or in 2022 — emerges as the largest dam of unpaid bills among the country’s major health insurers. In the first half of 2025, 41.8% of the value of hospital and clinic invoices sent to the company received no response after 60 days, almost double the previous year. In number of claims, the surge is even harder to justify: from 7.5% to 34.9%. This is no statistical blip; it suggests the adoption of a new operating model.
The mechanism is straightforward, though rarely stated plainly. In industry jargon, a “glosa” covers any claim that is not paid: returned, rejected, questioned or simply ignored. In practice, it is a suspension of cash. For hospitals, each glosa turns a delivered service into frozen revenue, while payroll, supplies and vendors come due every month. When this mechanism scales up, pressure on the care network is immediate: less liquidity, fewer investments and a higher risk of service disruption. In 2024, Anahp — which represents leading hospitals — counted R$ 5.8 billion in withheld payments; just 1.96% had technical justification. Nearly 42% of hospitals cut investments as a result.
Rede D’Or offered a hint in its third-quarter earnings call. Part of the imbalance may stem from SulAmérica’s still-unfinished integration: mismatched systems, misaligned processes and renegotiated supplier contracts. The narrative points to future efficiency. The present, however, tells another story. The insurer provided R$ 1.4 billion in positive working capital to the group over nine months — and with interest rates at 15%, each extra day holding cash is valuable. The contrast becomes clearer when considering one of SulAmérica’s legacy businesses, which at one point posted an extraordinary 89% non-response rate after 60 days — a level unmatched across the sector
This is not an accusation, merely an incentive pattern: when market share grows, so does the float. Asked to comment on the rise in withheld payments and on integration effects, SulAmérica did not respond.
ANS measures “non-responses” but not their consequences. Legislation sets deadlines, but does not penalise operators that turn delays into routine. The result is a market in which the dominant private group can operate with levels of arrears that would be unthinkable for smaller rivals. SulAmérica’s trajectory raises a question the sector can no longer ignore: how much of this performance reflects efficiency — and how much stems from a financial dynamic that has become too profitable to abandon? If glosa is an audit tool, fine. If it has become a strategy, the regulator has work to do — and quickly.
Claims Withheld Over 60 Days
(Large operators only)
| Operator | % of Claims Withheld (Value) | % of Claims Withheld (Number) | Average Payment Time (days) |
|---|---|---|---|
| SulAmérica* | 41.84% | 34.90% | 47.22 |
| Bradesco Saúde | 27.22% | 24.81% | 34.65 |
| Porto Seguro Saúde | 25.41% | 15.72% | 29.03 |
| Unimed Porto Alegre | 14.04% | 20.01% | 30.84 |
| Unimed Nacional | 10.51% | 14.33% | 24.10 |
| Sector Average | 16.86% | 12.84% | 33.61 |
| Amil | 1.72% | 2.17% | 19.99 |
| Unimed Seguros | 0.74% | 1.37% | 35.10 |
| Unimed Belo Horizonte | 0% | 0% | 36.07 |
| Hapvida Assistência Médica | 0% | 0% | 24.78 |
* SulAmérica Companhia de Seguro Saúde
Source: “Painel de Indicadores de Glosa”, Agência Nacional de Saúde Suplementar (ANS)