Health insurance changes leave many surprised with lack of cover
As a paramedic, Natalie Glaser has a highly stressful job, with long hours and shift work.
She went to her GP, complaining of an upset stomach.
“I was really scared as well, and I still am scared,” she told PM.
But when the doctor advised her to get a colonoscopy straight away, her anxiety grew further.
“My GP asked me if I’d like to go to the private hospital system or the public, and I took out my HCF cover because I said I’m sure I’m covered for this procedure,” she recalled.
“When I pulled it out and it said I wasn’t covered for it, I was quite confused.”
Natalie Glaser said she lost the majority of her coverage when HCF reviewed her policy and moved her down to a lower-cost, more basic level of coverage.
“I lost 18 out of 25 procedures — that’s about 72 per cent of my cover I lost.”
HCF informed Natalie Glaser via email in April 2019 her policy was changing from bronze level to basic, but she did not read it at the time, assuming it was a marketing message.
But there were big bold letters at the top of the email saying: “IMPORTANT CHANGES TO YOUR COVER”.
“You know, HCF themselves send hundreds of marketing emails a year, [and] I don’t tend to check all of them,” Ms Glaser said.
“And it’s not just HCF, it’s all companies send heaps of marketing every year.”
HCF has responded by saying that, when it has to make changes, it goes above the notification requirements of the Private Health Insurance legislation.
Where it is a significant change to hospital benefits, it told PM, HCF will provide 60 or more days’ notice.
It added that when it notifies members of any changes to their coverage or premiums, it does so according to the member’s preferred communication method, which is most commonly by mail or email.
Many people unsure about cover changes
But there is evidence Natalie Glaser is far from the only one confused by changes to her private health cover.
Insurance comparison website iSelect told PM it saw a surge in call volumes following the policy transfer process in April 2019, then again after the grace period ended this year.
“Certainly throughout September we’ve seen a big increase in the number of people contacting us to discuss how their policy has changed in terms of price or what they’re covered for,” iSelect spokesperson Laura Crowden told the ABC.
“And sometimes, from time to time, we do see a little bit of a spike based on one insurer making some changes to their policy at a particular time and they can happen out of the blue.”
Private Healthcare Australia represents the insurers, which have more than 13 million members.
CEO Rachel David said, as far as she is aware, missing emails is not a common problem.
“We haven’t seen an uptick in this sort of complaint, but people need to be pretty vigilant,” she told PM.
“That if they do get one of those emails, they need to check it thoroughly and ensure they understand the implications.”
Stephen Duckett, the director of the Grattan Institute’s health program, said private health funds have had the mammoth task of reviewing all of their members’ coverage to see where they fit into the new basic, bronze, silver or gold categories.
He told PM that while HCF has done nothing wrong, private health insurers should do all they can to make their coverage change email eye-catching, to prevent people like Natalie from being left without cover they thought they had.
“The notification from funds should be in big, bold letters [saying], ‘What we’re shifting you to is a package which only covers this: boom boom boom.’
“I think this is one of the issues. There is a private health insurance ombudsman who can take it up and say, ‘well, is this a fair deal?'”
Natalie Glaser took her concerns to both HCF and the ombudsman, but was told there was no legal avenue to pursue.
She is now trying to work out how she is going to afford a colonoscopy, and wants to warn others to avoid the pain she is experiencing.
“Because it was a real shock to me,” she explained.
“Once you realise, and then you’ve got to change back, there’s a 12-month waiting period to get back all the previous things you were covered for.”