LATAM Health Claims Observatory
The only independent radar of health insurance claim rejections in LATAM
We anonymously aggregate the real reasons insurers reject medical claims in Latin America. We update in real time. We publish our first monthly report on October 1, 2026.
Why this Observatory exists
In LATAM, no organization — public or private — transparently and systematically publishes the reasons insurers reject medical claims. The data exists (insurers, regulators and individual claimants have it), but it is never aggregated or shared.
We built the Observatory as a natural outgrowth of our free claim analysis service. Every conversation with our virtual specialist Izi generates a structured case with 15 anonymized fields: insurer, treatment, rejection reason, country, amount involved, urgency, sentiment and more. Everything is recorded in a database with automatic classification by category.
The result is a unique dataset: the first quantified snapshot of the claim-rejection ecosystem in Latin America. This Observatory publishes the aggregates openly. Individual cases are confidential by design.
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Distribution of rejection reasons (pilot sample)
Of the 43 cases analyzed between July 29 and August 11, 2026, this is the distribution of reasons identified. We publish counts with their base, not percentages: with a sample this size, a percentage suggests a precision we don’t have.
In 30 of the 43 cases there is no determined cause: the claimant didn’t have the official rejection letter at the time of the consultation. That’s an important signal — many people seek help before they have the technical diagnosis of the rejection. We’re working on requesting it as the first step. And if what worries you is the clock, see the filing and appeal deadlines for all six insurers.
Preliminary pilot insights
Two categories tie for first place in the sample
With 4 cases each, policy exclusion and annual limit exhausted are the two most frequently identified causes. Four cases out of 43 aren’t enough to speak of a market trend; they are enough to say what to look at first. Health insurance contracts are technical documents with specific clauses — understanding the exact reason for a rejection is the first step to acting within the formal process.
Only 7 of the 43 cases include the amount claimed
In 7 of the 43 cases the claimant stated how much money was at stake: between USD 300 and USD 8.500. In the other 36 it isn’t recorded. That’s why we don’t publish an average: calculating it from 7 cases and presenting it as the sample’s average would be inventing a figure. Asking for the amount at the start of the conversation is one of the fixes for the next cycle.
Insurers represented in the pilot sample
The pilot sample mostly reflects cases from international IPMI insurers — it does not represent the entire LATAM market. In future reports we expect growing representation from across the regional ecosystem.
Have a rejected claim? Join the Observatory
Every case analyzed helps build the map. The analysis is free, takes 3 minutes and is confidential. When you finish, your case is anonymized and added to the Observatory dataset.
Observatory Roadmap
October 1, 2026 — First full monthly report. We’ll publish the distribution by country, insurer, treatment and amount, with a large enough sample to segment without bias. It will include a comparison with the previous month.
November 1, 2026 — Interactive radar. Public dashboard with filters by country and insurer. Updated daily.
Q1 2027 — Open API. Aggregated data accessible via API for researchers, journalists, regulators and insurers who want to improve their processes.
Subscribe to the monthly report
On the first day of every month we send the full Observatory snapshot to your email. Free, no spam, unsubscribe anytime.
For press, regulators and researchers
If you’re a journalist, academic, public official or part of an insurer and want access to more granular aggregated data for reports or research, write to us directly at jb@seguros360.com. We share the aggregated datasets under an open license with attribution.
Our policy: individual data is never shared. Aggregates by category/country/insurer are, under a free-use license citing «Seguros360 Claims Observatory» as the source.
Contact
Individual cases for analysis: seguros360.com/en/free-claim-analysis/ · WhatsApp +1 (305) 610-5355
Press and aggregated data: jb@seguros360.com
This is a project of Seguros360, an independent wholesaler of international health insurance (IPMI) in LATAM. We do not represent any local insurer. The Observatory is a public service with no direct profit motive.
Do you know how many days you have left?
Each insurer sets its own deadline for submitting a medical expense and another, shorter one for appealing a denial. Once it passes, the expense can no longer be claimed — and nobody warns you. Enter your insurer and the date, and in two seconds we'll tell you how many days you have left and which article of the policy wording it comes from.
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