Ombudsman's 'State of the Health Funds Report' confirms a decline in complaints

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The Commonwealth Ombudsman has released its annual State of the Health Funds Report.

The report, which covers the 2021-22 year, found that complaints to the Ombudsman decreased by 22.7 per cent, "continuing a trend from the previous year."

"Part of the reason for the decline appears to be the long-term positive impact of the private health insurance reforms that came into effect from 1 April 2020," it said, highlighting changes to simplify products.

"More effective servicing of customers and more effective complaint handling by several health insurers also contributed to the decline in complaints seen by the Office. Private health insurance activity fell during COVID-19 restrictions as people were not always able to attend private hospitals, dentists and other providers. The effect of restrictions on complaint numbers seems to have been limited, however, as claims increased by 0.6 per cent in the year from June 2021 to June 2022."

According to the annual report, the Ombudsman received 2,704 complaints about private health insurance in 2021-22.

The most common complaints related to benefits, membership and service.

"Complaints about service and membership increased this year compared to 2020–21, while complaints about benefits decreased," said the Ombudsman.

"Complaints about benefits include those about general treatment (extras/ancillary) benefits and unexpected hospital policy exclusions and restrictions, typically about the amount paid for the service or timeliness in processing claims.

"Complaints related to membership cancellation generally reflect problems and delays in insurers processing requests to cancel memberships and handling associated payments or refunds. In most cases, they arise from consumers transferring from one insurer to another, rather than people leaving private health insurance altogether."