12 Sep 2016: Commonwealth Ombudsman responds to Bupa announcement

Commonwealth Ombudsman responds to Bupa announcement

The Commonwealth and Private Health Insurance Ombudsman, Colin Neave AM, will be monitoring Bupa’s response to the problems the private health insurer announced today with its assessment process for pre-existing medical conditions.

Between 2011 and May 2016, some customer claims were rejected by claims assessors without being reviewed by a Bupa medical practitioner.

“It is disappointing that Bupa’s processes for assessing pre-existing medical conditions broke down, but I welcome Bupa’s transparency in acknowledging the seriousness of the problem,” Mr Neave said.

“Bupa is taking proactive steps to assist affected customers and to correct its processes. My office will be monitoring Bupa’s efforts closely.”

A pre-existing condition is any ailment of condition that, in the opinion of a medical practitioner appointed by the insurer, a customer had signs or symptoms of during the six months before they acquired private health insurance or upgraded their level of cover. Private health insurers may exclude cover for pre-existing conditions for up to 12 months.

If current (and former) customers of Bupa have any questions about whether they are affected by this issue, they should contact Bupa in the first instance by calling 1300 510 736 or emailing Hospital.Review.AUS@bupa.com.au

“If customers remain dissatisfied after speaking with Bupa they should contact my office,” Mr Neave said.

More information about private health insurance, including a comparison of health insurance policies on the market today, is available at www.privatehealth.gov.au

The Ombudsman will make no further comments.

Media contact: 02 6276 3759