Are You Being Wronged by Your Health Insurer? See Why Complaints Are Skyrocketing!

Are you frustrated with your health insurer? You're not alone. Complaints against private health funds have surged in recent years, leaving many Aussie seniors questioning if they're getting value for money*.

The latest ‘State of the Health Funds Report’ from the Commonwealth Ombudsman revealed a whopping 26.8 per cent increase in complaints over the past year.



So, what's behind the rising tide of dissatisfaction? Let's take a deeper look at the key issues causing complaints to spike.

The Alarming Rise in Complaints

The Ombudsman's report showed a staggering 27 per cent increase in complaints about private health insurance in 2022-23. This surge can be attributed to several factors.

The Medibank Data Breach: The massive data breach at Medibank in October 2022 resulted in the theft of personal information from nearly 10 million customers, leading to a surge in complaints to the Ombudsman's office.

Cancellation Issues: A rise in cancellation complaints, particularly related to Peoplecare Health Limited (Allianz), contributed to the increase. Peoplecare, which provides health cover for overseas visitors and students, experienced a high volume of cancellation and refund requests as pandemic travel restrictions eased.



Premium Hikes Outpacing Inflation: Kate Browne, Compare Club’s Head of Research*, had this to say: ‘It’s understandable why people are dissatisfied with their health fund,’ explaining this happens ‘when premiums rise higher than inflation, but the service older Australians receive doesn’t match the price.’
She continued, ‘Everybody’s got a different perception of what good looks like, so the one question health fund members need to ask is, do you feel you’re getting value for money from your insurer? Loyalty is a two-way street. If you’re happy and are paying a fair price, great, but don’t be silent if you’re not.’


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Are you happy with your health insurance? Image Credit: Shutterstock



Which insurers received the most complaints?

Looking at raw numbers, Medibank came out ‘on top’ of the complaints table, with 29.5 per cent of all complaints (27.1 per cent market share). This placed them ahead of BUPA (23.7 per cent complaints with a 24.9 market share), HCF (13.5 per cent with a 12.5 per cent market share), and NIB (10.1 per cent with a 9.6 per cent market share).

Others ranking high on the complaints list include:
Australian Unity – 4.7 per cent (2.2 per cent market share),
HBF – 3.7 per cent (7.7 per cent market share), &
Teachers Health – 2.3 per cent (2.6 per cent market share).

What does market share mean in this context? The report states that 'where an insurer’s share of complaints was higher than its market share, this indicates that members of that insurer were more likely to complain than those of other similar sized insurers.'



According to Ms Browne, the report ‘highlights just how confusing Aussies find health insurance – even those who’ve held it for decades’.

‘My advice would be if you’re not sure about anything on your policy, ask … your fund, broker or expert*. The more informed you are, the more satisfied you’ll be when you find a good policy.’

Key Takeaways

  • The Commonwealth Ombudsman's annual report shows a 26.8 per cent increase in complaints about private health insurance.
  • A significant contributor to the spike in complaints was the Medibank data breach in October 2022.
  • Premium increases exceeding inflation and issues with cancellations and refunds are also causes for customer dissatisfaction with health insurers.
  • Medibank had the highest number of complaints.

How to change insurers*

If you feel unhappy with your health insurer, know that you have options. You can try reaching out to customer service to explain exactly where you see room for improvement. If you’re still unsatisfied, don’t hesitate to switch providers* or lodge a formal complaint.

One of the easiest ways to ensure you’re getting a good deal is to use an expert comparison service*. Compare Club is one of our long-term partners* with whom we have personally compared health insurers! You can read about Maddie’s experience here*.



The team at Compare Club* will make sure you have the health cover you need while paying a price you’re comfortable with*.

You get the peace of mind that comes with working with trusted professionals who have the years of experience* needed to navigate the complicated health insurance system and keep you from any further confusion.

You won’t lose anything by comparing; it’s completely free, and you only stand to save*! After all, if you don’t like the quote you receive from Compare Club*, you don’t have to do anything.

Have you had reason to complain against your health insurer, or have you recently changed insurers? Were you satisfied with the outcome?

Disclaimer: Advice given in this article is general in nature and not intended to influence readers’ decisions about investing or financial products. They should always seek their own professional advice that takes into account their own personal circumstances before making any financial decisions.

*Please note, members, that this is a sponsored article. All content of ours that has an asterisk next to it means we may get a commission to write an article or post a deal. We do this to assist with the costs of running the SDC. Thank you!
 
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Before finishing work we change our level of cover a couple of times to find the right mix. I really only kept it going to cover a regular test I have. Previously I had been out of pocket $100 to cover an outpatient admission for the specialist at a private hospital. We moved and I had to go with a different specialist/hospital. Out of pocket almost $3000.
Cancelled insurance and 🤞🤞for the public system now. Just cannot afford it.
 
The problem I find is, having health insurance you take it out thinking you are covered if you are sick and need it , but all too often there are issues with payment to cover things.All I want is to know I am covered and not have to Shop around for the best deal.It should be more like car insurance, most times you are covered if it's not your fault or you pay an excess if it is.
 
This data is misleading it is how many reports per company where it should be worked out as a percentage of the companies members. A company with lower numbers of complaints could have a higher percentage of its members than a bigger company.
 
What I don't understand is some funds have returned money to members, and although the amounts are minimal, come annual increased premiums time they get approved rises. So if they're returning money from the previous year, why would they qualify for a rise?
 
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My beef is with BUPA. After the recent increases they stated that theirs was 3.3%. I was shocked to see that mine went up by 4.93%. When I queried this I was told that the dental benefit had increased. I questioned whether all members had their dental benefits increased and was told they had. So BUPA have masked a premium increase with a minimal benefits increase. Doesn’t sound right to me!! Anyone else noticed this??
 
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Ian, I pay $58.44 fortnightly for HCF hospital and extra's. I use HCF dental clinic and have just had teeth cleaned and 2 fillings replaced at no cost. 🌻
What a bargain if ever I heard one!!!! 2 Fillings replaced..... that alone would be $500 ....
What extras do you have!!!! I just moved away from HCF as their premiums were to high....
 
What a bargain if ever I heard one!!!! 2 Fillings replaced..... that alone would be $500 ....
What extras do you have!!!! I just moved away from HCF as their premiums were to high....
I have Dental and Optical but have been with HCF or another fund for 50yrs. Maybe that makes a difference, as you get charged loading if you haven't been with a fund.
 
I have been with HBF for a long time, and I have had my money's worth with them, I find them good.
 
Before finishing work we change our level of cover a couple of times to find the right mix. I really only kept it going to cover a regular test I have. Previously I had been out of pocket $100 to cover an outpatient admission for the specialist at a private hospital. We moved and I had to go with a different specialist/hospital. Out of pocket almost $3000.
Cancelled insurance and 🤞🤞for the public system now. Just cannot afford it.
I opted out of Bupa. we have a public hospital nearby, only using extras , fees kept going up and up every so often . Only use it for teeth and glasses . Was costing me more for the insurance than I was actually using , Now saving the fee to pay for glasses and teeth. I'm in front. jay2
 
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Both mum and I (100 and 75 yrs of age) pay approx nearly $3000.00 a year each. Mum has been in hospital 3 times this year. Her last bill just for a room on her own was approx $7000.00. If you can afford to be in private health please do. To me the public hospital should be for the most poorly paid. Every one has their own opinion but private health works for us.
 
I arrived here from UK in 2017 on an Aged Parent Visa 0/10 804. I was told that I needed Overseas Visitors Health Cover - I have yet to discover if this was correct?
I took out OVHC with Allianz (a.k.a PeopleCare) and I stayed with them until February this year and left because of their outrageous price increase from $118 per month to $359 per month. I starting searching for another Provider and went to Compare Club. I gave them all the information re Visa status and Medicare card. They came up with HCF. They wanted a Lifetime Healthcare letter from Medicare - Medicare said that I wasn't entitled. HCF then said that I would be subjected to a 70% loading on the price. 2 months later it turned out that this was all wrong and I was directed back to OVHC again. I wish I could be sure!

The first card I received from Medicare lasted 5 years. When it came up for renewal I was told that this was an error and the next 2 cards were for 1 year and were yellow Reciprocal cards. The third one was an Interim card - which Medicare have said was wrong and it has been revoked and replaced by another Reciprocal card. I cancelled HCF and went to NIB. Spent ages on the phone, explained my situation and was accepted - based on my then Interim card. When this was revoked by Medicare I informed NIB and was told that this was still OK. From somewhere I remembered being told that holders of a Reciprocal card were not eligible for this Policy and so I questioned it further and finally insisted on speaking with someone senior. After much discussion and being kept on the phone, I was finally told that I was correct. So I had to leave NIB. I am nearly 90 and the last three months have been a nightmare. If anyone can point me in the right direction I would be so grateful All I want (if I need it) is a private room in hospital, ambulance cover and palliative care. I don't need pregnancy cover or teeth etc.
 
As we get older it is of great benefit to have private hospital and general cover because ‘things start to break down with age’. I moved from Bupa in 2004 and haven’t looked back. No excess & more things covered with my current fund, just a few $s more per fortnight but that’s OK for the benefits gained.
 
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