HCF has expressed disappointment a patient representative organisation issued a media release concerning the experience of one of its members without contacting the fund or checking the facts of the case.
The Australian Patients Association issued the statement regarding a 64-year old Melbourne woman. The statement claimed the patient, suffering chronic pain, was being forced to delay urgent ongoing hospital treatment after HCF "stopped covering her inpatient infusions and failed to inform her they were no longer covering her treatment."
“What concerns the APA is the fund did not notify the hospital or patient they were removing the cover. The key issue is that they are not informing patients, not paying the hospitals and refuse to speak to customer about the issue.”
However, in a statement, Jim Dertouzos, HCF's acting chief officer of member experience, said, “We’re disappointed to see the factually incorrect claims made by the Australian Patients Association. We’re sorry to hear that the member is suffering from a chronic condition and we sympathise with her situation."
HCF said it did not change the details of the patient's policy.
"The member’s claim was not paid because the hospital doesn’t have a rehabilitation Pain Management program as part of their contract with HCF," it said.
According to the fund, it supports the industry Guidelines for Recognition of Private Hospital-Based Rehabilitation Services which specifies a range of rehabilitation programs and their clinical admission criteria. It also said it has arrangements with other rehabilitation hospitals with contracted Pain Management programs where the member could have been treated and covered by HCF.
"When the member called us on 22 February, we told her that the claim from the hospital had been declined because they did not meet our criteria for that treatment. She was not told that we had stopped covering the treatment," it said.
HCF also challenged APA's claim the patient, who decided to leave HCF for another fund, will be forced to "wait in pain" while serving a mandatory waiting period before being able to access treatment.
Yet, according to HCF, "...the member cancelled her policy with us on 26 February and we ordered a transfer certificate which was sent to her new health fund today (28 February). This is well within the standard 14 day period for transfer certificates to be sent, therefore there should be no delay in her being treated assuming her new health fund has the appropriate contract with the hospital for this treatment."
The fund said it was disappointed the Australian Patients Association issued a media release without contacting it or checking the facts of the case.
"We agree that it is important for members to understand their health insurance policy and we encourage our members to review their policy regularly and ensure they are given informed financial consent by their hospital before starting treatment. We also provide a range of information to our members to help them prepare for going to hospital, which includes information on a range of procedures and a cost indicator tool.