# SulAmérica Turns Into Brazil’s Biggest Bill-Represser

*ANS data shows where the payments stall — and why that’s becoming hard to ignore.*

- Published: 2025-11-30
- Updated: 2025-12-01
- Author: André Vieira
- Section: Behind the Lines
- URL: https://brazilstockguide.com/behind-the-lines/sulamerica-payment-withholding-ans-rede-dor/

![](https://i0.wp.com/brazilstockguide.com/wp-content/uploads/2025/11/glosa.png?fit=1024%2C683&ssl=1)

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)*

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Source: Brazil Stock Guide, https://brazilstockguide.com/behind-the-lines/sulamerica-payment-withholding-ans-rede-dor/