Doctors calling for a health insurance clean up
Doctors have called on the federal government to clean up health insurance.
In a submission the government’s review of private health insurance, the Australian Medical Association (AMA) urged the government to stamp out private health insurance policies that exclude common procedures and only provide cover for treatment in public hospitals.
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The AMA suggests the government has failed to act on aggressive behaviour in this area from larger insurers and as a result has created what is described as a “rapidly declining situation”.
According to the AMA, this “aggressive behaviour” includes:
- Excluding treatments from existing policies.
- Removing services from schedules of medical benefits, with the result that the insurer will only pay the required 25% of the MBS fee for the service with patients incurring an out-of-pocket cost.
Entering into contracts with private hospitals that interfere with the established safety and quality system achieved by the accreditation arrangements.
Making direct calls to members encouraging them to downgrade their cover.
- Selling inappropriate policies, such as cover for obstetrics but not arthroplasty to older people, or cover for neonatal care but not if it is for cardiac or respiratory issues.
- Requiring detailed clinical information and justification to be submitted at the time of booking hospital treatment.
- Rejecting claims unless and until they are disputed by the patient or their doctor.
AMA stated, "These activities are serious enough to warrant strong and swift intervention by the federal government before consumer confidence in the private sector is undermined such that people drop their private cover altogether and/or turn to the public hospital sector for treatment."
Whether these concerns and recommendations will be taken into consideration in the government’s review remains to be seen, but one things for sure, they provide a startling look into the health insurance industry and how many insurers are using their power to manipulate customers.
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