2UE Mornings Interview in response to SMH 23/6/16 article: “Insurance ombudsman ‘a toothless tiger’

Station: 2UE
Program: Mornings
Date: 23rd June 2016
Time: 10:31 AM
Compere: Stuart Bocking
Interview with Dr Rachel David, CEO, Private Healthcare Australia
STUART BOCKING: Now we’re told that some of the Medibank members who sought help from the Private Health Insurance Ombudsman about some of the shock hospital bills- this was after that policy change that they’re now having strife over, were pretty much left to fight it out alone. Now you’ve got to wonder about all of this. You have a concern, there is a dedicated ombudsman to deal with them but people feeling that for whatever reason they were left to just work it out for themselves. Dr Rachel David is with Private Healthcare Australia and is on the line. Dr David, good morning.
RACHEL DAVID: Good morning Stuart.
STUART BOCKING: Would this be right, I mean the suggestion the insurance ombudsman is little more than a toothless tiger?
RACHEL DAVID: Look I can’t comment on the specific case with Medibank. There are a number of regulators and rules which govern private health insurance and the ombudsman is one avenue that people have to make complaints or make their views known if they have an issue with a fund. What I would say is that the private health system is very very complex, so it might not be straight forward to deal with some complaints when they come up. One difficulty we do have is with the issue of out of pocket costs because health funds are not able under the current laws to control the out of pocket costs that specialists and providers charge. So there are already two parties in that transaction and it can be very hard for consumers to navigate the system.
STUART BOCKING: Is it unusual for health funds to just change the details of policies what you’re insured for in the middle of a policy?
RACHEL DAVID: Well look these issues are incredibly complex because the providers can change what they do, they can change what they charge – and we also have a very large number of policies in the market as well as a number of members that need to be informed. So one thing the industry is committed to as a result of the federal government’s private health insurance review is to make a considerable investment ourselves in making the system easier for consumers to understand. So collectively health funds are going to be working together to help consumers navigate between their product to find one that is most suitable for their needs, but also to help doctors and GPs work with consumers to navigate the system to find services and specialists which have no or minimal out of pocket and to better find specialists and providers that meet their needs. So there’s those two aspects to it, but I would stress the system is very complex and there really is no quick fix to this.
STUART BOCKING: Look I can understand that but I mean it’s the line of work that private health companies are in, I mean that is their area so they’ve got to be across it all. If coverage for hospital tests like ex-rays, CT scans are being altered in the midst of a policy where people are paying their premiums either up front or month to month, are you not entitled to think that you’d get some sort of letter at least alerting you to what some of the changes are?
RACHEL DAVID: Yes and I think in terms of the specifics of the Medibank case I’m not able to comment on those but as an industry we do need to look at ways we can do this better and communicate with consumers in ways that are both convenient and that they can understand. Part of the challenge is to make sure that we all use the same terminology and medical terminology so different funds are not saying different things for different people about what their policies cover. We need to do some work on that.
STUART BOCKING: But it’s also common sense, I mean if you’re locked into an arrangement and suddenly for whatever reason the amount that’s delivered to you has to change or there are other fundamental changes to what’s happening, well surely there’s some sort of basic communication correspondence with the customer to say look just to put you in the picture this is what’s happening as of date x.
RACHEL DAVID: Yes and I think the majority of funds do actually do that to some extent but as an industry we need to look at making sure that consumers have the best tools available to them to understand the system. Whether that’s using new technology, using SMS or other technologies, developing the right understandable plain English terminology to communicate with people, these are all things that we need to look at. But also some of these very real concerns that consumers have raised.
STUART BOCKING: Because you can understand there’s a degree of cynicism as it is around insurance more generally but particularly with private health insurance, people don’t like the nasty shock when they go to claim. At least if you’ve had some notification you might be bracing yourself for it but in a lot of these case, changes have been made, no one had any idea until they went to make a claim on their policy.
RACHEL DAVID: Yes and I understand that as well as a health consumer. Yes the health funds have that responsibility and we have made that commitment to workers and industries to do this better, but I’d also say that the entire sector including the hospitals and the medical specialists that work within them need to share in that responsibility because ultimately health funds issue the policy but they have no direct control over out of pocket costs that doctors and providers charge.
STUART BOCKING: Well a level of communication obviously important. I appreciate your time.
RACHEL DAVID: Thank you very much.
STUART BOCKING: Thank you. Dr Rachel David who’s from Private Healthcare Australia. And if you have had some dealings with the private insurance ombudsman, what did you find? What sort of response did you get? Let us know.
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