26 September 2023

Healthy report on insurance complaints

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Australians were reported to have lodged almost 3,500 complaints with the Private Health Insurance Ombudsman in 2020-21, a number 5.7 per cent less than that lodged in 2019-20.

Delivering the 17th annual State of the Health Funds Report, Acting Commonwealth Ombudsman, Penny McKay said the most common issues in consumer complaints related to benefits, membership and service.

“Complaints about service increased this year compared to 2019-20, while complaints about benefits and information decreased,” Ms McKay said.

“When consumers contact us about an insurer’s service, it is rarely the sole reason for their complaint,” she said.

Ms McKay said past experience showed complaints usually flowed from another issue which, when combined with poor customer service, inadequate or delayed responses and poor internal escalation processes, caused policy holders to become increasingly dissatisfied.

“Complaints about information include complaints about verbal advice, where the insurer and member disagree about what information was provided in a phone call or retail centre,” she said.

The Acting Ombudsman said that in addition there were complaints about the clarity or accuracy of written information on websites and in brochures, email or letters.

Ms McKay said the Ombudsman Act required her to publish a report after the end of each financial year.

“The Report provides comparative information on the performance and service delivery of all health insurers during that financial year,” she said.

“For existing policy holders, the Report details information that allows them to compare the performance of their insurer with all other health insurers, while for those considering taking out private health insurance for the first time, it outlines the services available from each insurer and compares their performance,” Ms McKay said.

The Ombudsman’s 24-page Report can be accessed at this PS News link.

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