The private health insurance watchdog is experiencing a surge in complaints about benefit reductions and exclusions as funds cut cover while increasing premiums.
As funds introduced their annual premium increase this week, the Private Health Insurance Ombudsman released its yearly State of the Health Fundsreport, which showed a 34 per cent increase in complaints about exclusions and restrictions last financial year, compared to the previous 12 months.
Fairfax Media reported last month that two of the nation’s largest insurers had cut the amount it will refund members for natural therapies, remedial massage and healthy lifestyle benefits such as gym memberships.
Overall, the Ombudsman received 3427 complaints in 2013-14, a 16 per cent increase on 2012-13.
Over this period, the number of people with private cover grew by 2.7 per cent, but the Ombudsman said the number of complaints was “very small” compared to fund membership of more than 11 million.
Complaints about the oral advice funds provided to their members were up 40 per cent, while high level complaints – those requiring intervention from the Ombudsman – were up 28 per cent.
Among the largest funds, BUPA, HCF and NIB made up a greater proportion of complaints than their market share, meaning members of those funds were more likely than average to complain to the Ombudsman.
The nation’s second largest insurer, BUPA, attracted 1040 complaints in 2013-14, 400 more than its larger rival, Medibank.
BUPA’s health insurance managing director Dwayne Crosbie attributed the increase in Ombudsman complaints from BUPA members over this period to changes the company had made to its complaints handling procedures. Dr Crosbie said since then the company had given case managers more power to resolve issues, and this had reduced complaints to the Ombudsman.
“We dropped the ball and we managed to pick it up again,” he said.
In the three months to December 31, BUPA, which has a market share of 26.7 per cent, accounted for 23.4 per cent of complaints to the Ombudsman.
A spokesman for NIB said its complaint numbers were “above where we would like them to be”, and highlighted “an opportunity to further improve our relationship with customers”.
Overall, the increase in complaints has continued this financial year, with the Ombudsman receiving 981 complaints in the three months to December 31, 28 per cent more than the same period the previous year.
In its most recent bulletin, the Ombudsman notes large increases in complaints about benefits and fund rule changes.
The Ombudsman said many of these complaints occurred because people were sold a policy that excluded procedures that the customer thought they would not need, such as joint surgery, gastric banding or obstetrics, only to find out later they did need such cover.
“By taking a lower level of cover, consumers are increasing the risk that they might not be covered for certain treatments,” the Ombudsman wrote.
Matthew Cuming, a spokesman for health insurance comparison website iSelect, said that consumers had become increasingly concerned about the affordability of private health insurance over the past 12 to 18 months, and were seeking policies with exclusions to reduce their premiums.
“They don’t want any fat in the policy. They don’t want features that they’re not going to use,” Mr Cuming said.
Funds this week increased their premiums by a weighted industry average of 6.2 per cent. However some members face increases of two to three times this rate, and affordability concerns have been exacerbated by changes, which also took effect this week, that further erode the value of the Private Health Insurance Rebate. While the rebate available to those under 65 was once 30 per cent, the maximum is now 27.8 per cent.
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