The Commonwealth Ombudsman has released his latest State of the Health Funds report detailing the performance and service delivery of Australia’s health funds during 2019-20.
The Ombudsman, Michael Manthorpe (pictured) said his Office received 3,706 complaints during the period, an 8.3 per cent decrease on the previous year’s total.
He said concerns about benefits, membership and service were the major cause of complaints.
“The most significant benefit complaint issues were general treatment (extras/ancillary) benefits, and complaints about unexpected hospital policy exclusions and restrictions,” Mr Manthorpe said.
“This year there was also a significant increase in the number of complaints about membership suspensions due to COVID-19.”
He said that in the February-to-June 2020 period, the Office received 212 complaints related to COVID-19.
“The majority of these complaints raised issues related to suspension requests, premium costs and the inability to access hospital and general treatment services as planned,” Mr Manthorpe said.
He said almost all insurers postponed their 1 April 2020 premium increases for at least six months to 1 October 2020.
“The majority of insurers also introduced provisions to provide financial relief to people who had lost their jobs, were underemployed, in hardship or had contracted the virus: and most insurers covered COVID-19 treatment for existing policyholders,” the Ombudsman said.
“I encourage consumers to contact their insurer in the first instance if they have any questions or concerns regarding their membership.”
The Ombudsman’s full report can be accessed at this PS News link.
