Health insurance complaints down, but issues remain

The gap between how much a consumer pays in hospital fees and how much their health fund covers is still causing headaches.
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01.Ask your doctor about "the gap"

Doctor in hospital noting down information about the patient's health

Complaints about health insurance are down, but consumers still need more information about the gap between the amount their doctor charges and how much they get back from their private health insurer, according to a recent report.

The 2012-13 State of the Health Funds report, released by the Private Health Insurance Ombudsman (PHIO), found: 

  • A slight overall decrease in consumer complaints about private health insurance
  • A 29% drop in higher level complaints
  • Overall, the number of complaints related to health insurance is low compared with other industries such as telecommunications or finance.

According to the ombudsman, the issues that caused the most complaints were related to advice given by insurance company staff in branches and call centres and also pre-existing conditions waiting periods, which are usually 12 months for most health conditions when you take out hospital cover for the first time.

To make sure you're as informed as possible about any gap you may be liable for, if you need to go to hospital, ask your health fund about: 

  • How much cover they provide for the hospital stay 
  • What excess and/or co-payment you're going to need to pay
  • How much you should expect to pay in out-of-pocket costs for doctor's charges 
  • How to use the fund's gap scheme to minimise the gap. This may include contact details of doctors participating in the fund’s gap scheme.

And ask your doctor about: 

  • How much they estimate your procedures will cost all-up (this should be a written statement)
  • Any out-of-pocket costs
  • Information on how to find out how much you'll have to pay for other doctors who might be treating you as well, such as the anaesthetist.

For more information, see the PHIO brochure about doctors bills.

For information about how to reduce your health insurance premium costs, see our reports about extras insurance and switching health insurance. You can also read about whether the sale of Medibank Private will have an impact on health insurance premiums.



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