Bupa medical gap scheme to continue to be available for public hospitals

Posted: 9 June 2018 7:41 am
Doctor speaking with patient

Doctor speaking with patient

Bupa accepts recommendations from Commonwealth Ombudsman.

Bupa will not be going ahead with its plans to stop patients accessing its medical gap scheme in public hospitals, meaning that Bupa members "who are treated in a public hospital can have peace of mind around out-of-pocket costs while maintaining a choice of doctor".

“It means if a doctor elects to use the scheme in a public hospital, then members will face no additional out-of-pocket costs in an unplanned admission such as through emergency and no more than $500 for each doctor or specialist for pre-booked procedures. This means members have certainty over their doctors’ fees," Bupa Australia and New Zealand CEO Richard Bowden said in a statement.

In February 2018, Bupa announced that it would be making changes to its Gap Scheme, which was met with some consternation and concern. In light of this, the minister for health Greg Hunt asked the Commonwealth Ombudsman to investigate how these changes would impact consumers.

The report highlights the negative impacts on consumers (especially those in regional areas) and the appropriateness with which Bupa communicated these changes to its members.

“While it is a commercial decision for Bupa to determine the extent of the cover it provides over and above its statutory requirements, it is imperative that the policy changes are explained in plain English and in a way that prominently communicates their potential impact to the consumer,” the Ombudsman noted.

The report made two recommendations with regards to how Bupa communicated these changes, both of which were accepted by Bupa.

“We’ve spoken with the Commonwealth Ombudsman and agreed to make sure customers fully understand how the removal of minimum benefits may impact them, a contribution paid to the cost of a small number of expensive procedures for customers on basic and mid-level policies,” Bowden said.

In response to the report, the Australian Medical Association (AMA) said that while Bupa is doing the right thing restoring transparency to its cover it is worried that because insurance is a complicated product and that "without clear and meaningful coverage levels, patients will continue to question their insurance".

“We remain critical that Bupa policyholders will not be able to use their ‘no gap’ or ‘known gap’ cover in non-contracted facilities. This remains a major concern for the AMA as it means that patients will still be required to ascertain whether their surgeon and their hospital have a contract with Bupa," said AMA president Dr Tony Bartone in a statement.

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