Ombudsman: No spike in complaints for September quarter

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The ombudsman has reported 1,029 private health insurance complaints in the three months to the end of September 2019 - a small 2 per cent rise compared to the three months to the end of June and no change compared to the corresponding quarter last year.

The report covers the period including the ongoing introduction of policy categorisations (Gold, Silver, Bronze and Basic) and standard clinical categories meant.

The top-five complaint sub-issues during the quarter related to verbal advice (99), general treatment (99), pre-existing conditions waiting period (75), hospital exclusions and restrictions (69) and membership cancellation (61).

On verbal advice, the ombudsman said most complaints concerned "poorly communicated advice to people over the phone or at a retail centre, particularly where records are not adequately maintained."

On complaints about general treatment, they said, "These complaints usually concern disputes over the amount payable under ‘extras’ policies such as dental, optical, physiotherapy and pharmaceuticals, or the insurer’s rules for benefit payments (such as certain minimum claim criteria)."

The majority of complaints remained about private health insurers but this is consistent with previous updates. 

"A comparison of the previous four quarters shows complaints about different provider and organisation types remains generally steady. Complaints about overseas visitors and overseas student insurers continue to increase, with 132 complaints this quarter compared to 111 complaints in the same period last year—an increase of 19 per cent," said the ombudsman.