Ombudsman responds to Bupa

The Commonwealth and Private Health Insurance Ombudsman will be monitoring Bupa’s response to its problems with the 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.

 

The Commonwealth and Private Health Insurance Ombudsman, Colin Neave said, “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 This email address is being protected from spambots. You need JavaScript enabled to view it.

 

“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

 

14 September 2016.