Will the receipt from a Brazilian clinic satisfy my insurer at home?

By Ramon Martins Andrade, attorney (OAB/RJ 188.374)

The electronic receipt a Brazilian health professional must issue is an instrument of Brazilian income tax: its mandatory fields include the CPF of the provider, of the beneficiary and of whoever paid (Normative Instruction RFB 2.240/2024, article 5, I). A patient with no Brazilian taxpayer number is outside it by the design of the rule. What should travel home with you is the clinic’s invoice as a legal entity and a written discharge of the payment, both obtained at the counter.

No Brazilian rule obliges a clinic to use your insurer’s format or to translate anything. I would put it positively: you can require a correct and legible statement of what you paid, for what, to whom and when. Converting that into the insurer’s form is your side of the work.

Who is being paid decides which document exists

Two documents sit behind the same desk. The Receita Saúde “pode ser emitido somente por profissional de saúde pessoa física com registro regular perante o respectivo conselho profissional” (may be issued only by an individual health professional holding regular registration before their professional council; article 2, our translation). Pay a company and that receipt does not exist for your payment; its service invoice does. Article 3 makes issuance mandatory, at the moment of payment, for a closed list of six professions. So the question to settle before paying is which of the two will put its name on the document.

At the counter, the lever is the Civil Code

Tax rules say what a Brazilian receipt contains; they are not what puts one in your hand. The Civil Code is: “O devedor que paga tem direito a quitação regular, e pode reter o pagamento, enquanto não lhe seja dada” (a debtor who pays has a right to a regular discharge, and may withhold payment until it is given; article 319, our translation). Article 320 lists what it must designate: the amount, who paid, when and where, and the creditor’s signature. To my mind this is the strongest documentary instrument a foreign patient has here, the only one that works while the money is still yours. Consumer law adds the price side: article 6, III, of the Consumer Protection Code requires clear information on the service, the applicable taxes and the price. A line reading only “aesthetic procedure” satisfies neither that provision nor any insurer.

Back home: what the insurer asks, and what nobody owes it

The Receita Saúde is a “documento hábil à comprovação de despesas com saúde” (a document fit to evidence health expenses; article 1, our translation) for a Brazilian income-tax instruction, and the deduction it serves, under Law 9.250/1995, is admitted only on proof naming the payee, with address and taxpayer number. Strip the tax purpose away and it is a checklist for any insurer: payee identified, service specified, date, amount.

The paperwork also tends to land on the patient. Panteli, Wagner, Verheyen and Busse, in the European Journal of Public Health in 2015, reported a postal survey by a large German sickness fund among members treated in other European countries: of 17,543 respondents, exchange of information between providers across borders was rare and “largely carried out by the patients themselves”, and the authors concluded that patients need more guidance on documentation rights and requirements. It is European, from 2015, limited to one insurer’s members, with 41% responding, and measures nothing about Brazil.

The set to assemble is short: the invoice naming the payee and describing the service, the discharge of the payment, and the clinical record of what was done. The last is a separate request with rules of its own, set out in How do I get my medical records from a Brazilian hospital after leaving Brazil?. If what you received falls short and the clinic has stopped replying, you can get in touch with the firm and set out what was handed to you and what your insurer refuses to accept.

Europe turned the invoice into a duty; Brazil left it to the contract

Europe wrote the obligation Brazil never wrote. Under Directive 2011/24/EU, on patients’ rights in cross-border healthcare, Member States must ensure that providers “also provide clear invoices and clear information on prices, as well as on their authorisation or registration status, their insurance cover” (article 4(2)(b)); article 10(1) obliges the states themselves to assist each other in clarifying what an invoice says. None of that binds a clinic in Rio de Janeiro, and a patient from outside the European Union has no equivalent to invoke. My conclusion from the contrast is that documentation for a foreign patient in Brazil is a contractual question, not a regulatory one, and belongs in writing before the procedure: which entity will invoice me, in whose name, with what description of the service, and by when.

Ramon Martins Andrade (OAB/RJ 188.374) is a Brazilian lawyer, graduated from UFRJ in 2011, with master’s degrees from the Université Sorbonne Nouvelle and from the Naval War College (EGN, Brazilian Navy). He is currently a researcher in Human Rights and Health at ENSP/Fiocruz.

This content is for information and education only. It does not constitute legal advice, advertising of results or any guarantee of outcome, under Rule 205/2021 of the Brazilian Bar Association (OAB).