The top five private health insurance complaints

Peter Terlato 17 February 2017

Patient hospital unhappy annoyed complaint

Payments and oral advice to blame for increased complaints.

Premium payments and issues regarding the provision of oral advice were responsible for the greatest number of complaints to the Private Health Insurance Ombudsman (PHIO) in the December quarter 2016.

Following an unusually high number of complaints in the September 2016 quarter, the latest PHIO figures show a slight reduction during the December 2016 quarter. However, last quarter's numbers represent a 25% increase on the same period in 2015.

The majority of complaints were related to Australian health insurers (1,504 complaints), followed by overseas visitor and overseas student health insurers (95 complaints).

Complaints by provider or organisation type

Provider or organisation typeSeptember 2016 QuarterDecember 2016 Quarter
Health insurers15041067
Overseas visitor & overseas student health insurers14395
Brokers and comparison services1615
Doctors, dentists, other medical providers35
Hospitals and area health services124
Other (e.g. legislation, ambulance services, industry peak bodies)1117

The top five consumer complaints for the December quarter were driven by problems with payments. There were 102 complaints last quarter, primarily relating to complications with direct debit, such as incorrect or irregular transactions and accidental cessation of direct transfers.

Fairfax Media reports the bulk (48.4%) of these were caused by IT problems at one insurer, Medibank.

The second-highest number of complaints were about oral advice, usually over the phone or during a visit to a retail branch. Misunderstandings occur, particularly when customer records are not maintained.

There was also a large number of complaints regarding membership cancellation and delays, hospital exclusions/restrictions, assumed benefits and general treatment.

Health insurance premiums are set to rise in 2017, encouraging many Australians to switch providers.

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