Fall in Health Insurance Complaints

17 February 2017
The latest data from the Private Health Insurance Ombudsman shows Australians made fewer complaints about health insurance over the December quarter.

The December 2016 quarter (1 October – 31 December) saw a 29% drop in complaints compared to the September 2016 quarter. The Ombudsman fielded 1,067 complaints in the December quarter compared to a much larger 1,504 complaints in the September quarter.

According to the Ombudsman, the top five consumer issues for the quarter were:

  1. Premium Payment Problems: 102 complaints – Issues with direct debits from bank accounts and credit cards, where the debits were irregular or for an incorrect amount. A majority of these complaints stemmed from IT issues with one insurer.
  2. Oral Advice: 101 complaints – Most of these complaints stemmed from consumers misunderstanding the explanation of their benefits they received during phone calls and visits to branches.
  3. Membership Cancellation: 79 complaints – Complaints concerning delays in the processing of cancellation requests, and subsequent issues with payments/refunds.
  4. Hospital Exclusion or Restriction: 68 complaints – Generally stemming from consumers misunderstanding their policy and assuming they were covered for a service or treatment that they were not covered for.
  5. General Treatment (Extras/Ancillary): 67 complaints – Generally caused by consumers receiving a lower benefit than initially expected.

Complaints declining after steady increase

The recent decline in the number of complaints received in the past two quarters appears to be a stabilisation after the record numbers of complaints received in mid-2016.

Prior to the September quarter, health insurance complaints had been on a steep upward curve. While the number of complaints from the September quarter is not-insignificant, 2016’s July quarter saw the Ombudsman receive a total of 1,683 complaints, the largest number of complaints received in a single quarter in the PHIO’s history.

Many speculated that the record-high number of complaints was related to yearly premium increases.



Private Healthcare Australia Chief Executive Dr Rachel David said the latest drop in complaints supports recent IPSOS research showing that 84% of health fund members value their insurance policy.

These members value the security and confidence of having access to private medical treatment when and where they need it, according to the research.

To put these high numbers of complaints in perspective, Dr Davis says the latest government statistics show that 13.5 million Australians have some form of private health insurance.

She added, “Health funds are making a considerable investment in work to help consumers navigate a complex system, including making it easier to choose health fund products based on cost and need.”

Ombudsman: Still a 25% increase from December 2015 quarter

In the quarterly bulletin, the Ombudsman pointed out that the December quarter is usually a ‘quieter’ period for private health insurance.

“While this [latest complaint figures] was a reduction on the previous quarter, it was still a 25% increase on the 964 complaints received in the same quarter in 2015,” it reported.

The Ombudsman’s full bulletin can be found here.

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