The Private Health Insurance Ombudsman’s 2011 Annual Report notes a significant increase in overall complaint numbers

The Ombudsman comments that “the issues in 2010-11 where there was an increase in complaints include level of cover, fund rule changes and general service issues. The increase in complaints about these issues is not across all insurers, but is generally confined to two or three of the larger insurers, who made changes to their products last year that affected large numbers of members.”

The Report makes recommendations and contains case studies relating to communicating changes in hospital cover.

The Private Health Insurance Ombudsman’s Quarterly Bulletin 59 contains some interesting statistics about health insurance complaints: volume, type and by insurer compared to market share.

Your complaints handling procedures should set out in writing:

(a) the procedures and policies for:

• receiving complaints;
• investigating complaints;
• responding to complaints within appropriate time limits;
• recording information about complaints;
• identifying and recording systemic issues;

(b) the types of remedies available for resolving complaints; and

(c) internal structures and reporting requirements for complaint handling.

You should provide a copy of the procedures to all relevant staff. A simple and easy-to-use guide to the procedures should also be made available to consumers, either on request or when they want to make a complaint. The information should be placed on your website.

Langes+ have experience in designing complaints and dispute resolution procedures.

In L v Health Service Provider [2009] PrivCmrA 15 a patient complained to the Privacy Commissioner when his payment default for health services was listed in his consumer credit information file. While the complainant had failed to pay for the medical procedure, the Commissioner considered the health service provider did not have a sufficient credit relationship with the complainant, and was not a credit provider in accordance with Determination No. 2006-2.

The Commissioner formed the view that the health service provider had interfered with the complainant’s privacy by listing a payment default when it was not a credit provider in respect of the debt. In response to the complainant’s claim that the payment default prevented them from obtaining finance, the health service provider apologised, removed the payment default, and ceased its practice of reporting overdue accounts to a credit reporting agency. The complainant also accepted a confidential financial settlement.