What is the Private Health Insurance Ombudsman?

What the Private Health Insurance Ombudsman does and how they deal with complaints about health insurance.

What is the Private Health Insurance Ombudsman?

The Private Health Insurance Ombudsman (PHIO) is an independent organisation that protects the interests of people with private health insurance. They do this by helping resolve complaints between consumers and their health insurance provider, providing information to the public about health insurance, monitoring the industry, and providing advice to government and industry.

Aside from complaints, you can also contact the Private Health Insurance Ombudsman for advice regarding your health insurance (Hotline 1300 737 299).

The Private Health Insurance Ombudsman puts out several publications that are useful for health insurance members:

You can find Canstar’s summaries of the main things you need to know in our health insurance articles:

What you need to know about Health Insurance

Making a complaint about health insurance

If you make a complaint with your health fund provider and they do not resolve your problem to your satisfaction, you can make a complaint about your health insurance to the Private Health Insurance Ombudsman. The Ombudsman also handles complaints between private hospitals or medical practitioners and health funds.

You can contact the Ombudsman by the online PHIO Complaint Form, over the phone (Hotline 1300 362 072 open 9am-5pm Mon-Fri (Sydney Time)), or via email (phio.info@ombudsman.gov.au). When making a complaint to the Private Health Insurance Ombudsman (PHIO), the complaint form is on the Commonwealth Ombudsman’s website, but don’t worry that the name is different – your complaint will still go to PHIO.

Every year, the Ombudsman publishes a report showing each health fund’s performance, including the total number of complaints received. Apparently, people are more unhappy with their health insurance than ever before. The top 5 health insurance complaints made to the Ombudsman in the September 2016 quarter showed a 60% increase in the number of complaints from the same quarter in 2015.

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