Hike in health insurance complaints: here are the top five

Peter Terlato 5 August 2016

Complaint

A significant rise in complaints during the June quarter.

Approaching the end of the financial year, the number of complaints from Aussies unhappy with their health insurance rose decidedly, relating to issues of administration, membership and service.

In the three months to June 2016, the Private Health Insurance Ombudsman received 1,367 complaints, one-third (33%) more than the previous quarter and 12% higher than during the same period last year.

Almost half (47.8%) of all the complaints received were in reference to Medibank Private & AHM. Around 16% of complaints were related to BUPA and even fewer for HCF (9.7%) and NIB Health (6.4%).

To put these figures into perspective, these four companies combined account for more than 70% of the total market share of Australian health insurers.

These were the top five consumer complaint issues this quarter:

  1. Oral advice - 136 complaints - Misunderstanding of policy benefits, on phone calls and retail branch visits.
  2. Membership cancellation - 122 complaints - Mainly concerning refunds and administrative issues.
  3. Clearance certificates - 121 complaints - Problems and delays transferring patient histories and info.
  4. Premium payment problems - 105 complaints - Direct debits from bank accounts and credit cards.
  5. General service issue complaints - 94 complaints - Delays or inaction from customer service staff.

Health insurers are allowed to apply a 12 month waiting period to claims deemed to be the result of preexisting conditions (PECs). While the number of complaints about PECs has been relatively consistent over the years, the majority of decisions are not overturned.

The Ombudsman says insurers should properly identify signs and symptoms and options relating to proposed procedures or hospitalisation for PEC customers to help minimise complaints.

When choosing a health insurance fund, you're likely to be worried about costs and which services you'll be covered for; however, gap payments are something you need to consider.

If you're confused about how to claim on your private health insurance, find out how using our simple guide.

Picture: Shutterstock

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