AGCM

The Authority found several delays in the handling and settlement of reimbursement cases, difficulties for policy-holders in contacting the assistance service, and also a number of unjustified rejections of reimbursement requests and authorisations for direct healthcare services.

The Antitrust Authority has imposed a fine of €2.5 million to Intesa Sanpaolo RBM Salute S.p.A., an insurance company specialising in health insurance, and a fine of €1 million to Previmedical Servizi per la Sanità Integrativa S.p.A., a service provider entrusted with the management and settlement of claims.

The investigations were initiated following reports from numerous consumers and the results of supervisory activities carried out by Ivass (Institute for the Supervision of Insurance). During the course of the proceedings, further requests for intervention from consumers complaining about the same critical issues were added. Many complaints came from members of the MetaSalute health fund, which alone accounts for more than a third of ISP RBM’s policy-holders.

The conduct of Intesa Sanpaolo RBM Salute S.p.A. and Previmedical Servizi per la Sanità Integrativa S.p.A. constitutes unfair commercial practice in breach of Articles 20, 24, 25(1)( d) of the Consumer Code, as they have been found to have hindered the exercise of consumers’ contractual rights, making the use of insurance services burdensome.

In particular, problems emerged at Previmedical’s operations centre (which occurred at the end of 2022) that led - as of early 2023 - to the build-up of an extremely high number of cases waiting to be processed, significantly later than the settlement times set forth in the respective health policies. The accumulated delay also caused difficulties in the day-to-day handling of subsequent service requests, with huge delays with respect to the contractual provisions. In addition, problems at the operations centre made it difficult for consumers to get in touch with customer service.

In addition, there were several inconsistencies in the practical application of the policy conditions by Previmedical, also due to the difficulty in interpreting the settlement practices established by Intesa Sanpaolo RBM Salute, which resulted in numerous cases of erroneous rejection of authorisations or reimbursements to entitled persons, or the unnecessary request for additional documentation.

Lastly, the elements that came to light during the course of the investigation highlighted the responsibility of Intesa Sanpaolo RBM Salute S.p.A. in the failure to implement an effective control system on the claims management activities of its provider, so as to prevent and manage any critical issues in the management of health policies and to guarantee its policyholders an adequate level of service.

Rome, 21 May 2024