The Australian Competition and Consumer Commission (ACCC) has taken Medibank Private to court, alleging the health insurer made false representations about benefits covered by its health insurance policies.
Chair of the ACCC, Rod Sims said it alleged Medibank’s subsidiary ‘ahm Health Insurance’ falsely represented to some members making claims or enquiries relating to cover for joint investigations or reconstruction procedures that they were not entitled to cover when in fact their policies covered those procedures.
“We will allege that Medibank incorrectly rejected claims or eligibility enquiries from over 800 members for benefits that they were entitled to and were paying for,” Mr Sims said.
“As part of our case, we estimate about 60 members needlessly upgraded their policies so they could access the joint investigation and reconstruction procedures they were already entitled to under their existing, cheaper insurance policies.”
He said ACCC further alleged that in some cases members who upgraded their policies were also required to serve a further waiting period to access the procedures.
“Medibank’s alleged misrepresentations had serious consequences for members requiring procedures including spinal surgery, pelvic surgery, hip surgery and knee reconstructions, which often cost thousands of dollars,” Mr Sims said.
“Some members were forced to delay surgery due to high out-of-pocket costs for these procedures and to seek alternative remedies to manage pain, when they were in fact entitled to insurance cover.”
He noted that Medibank had self-reported this conduct to the ACCC and had begun compensating affected members.
“The ACCC is seeking penalties, consumer redress, declarations, injunctions, publication orders, the implementation of a compliance program and costs,” he said.
