Health cover complaints spike as HCF customers vent

Apr 19, 2021
The Ombudsman has revealed which health insurers made the quarterly naughty and nice list. Source: Getty

A dodgy IT update has been blamed for hundreds of complaints lodged against one of the country’s biggest private health insurers. Hospitals Contribution Fund (HCF) customers were left frustrated when the provider’s website update and issues with the phone system prevented them from being able to contact the insurer and process claims.

HCF acknowledged there were “teething issues” with the IT upgrade, but says all complaints and tech issues have now been resolved.

The Ombudsman received 868 health insurance complaints for the October1–December 31, 2020 quarter, an increase of 7.8 per cent compared to the same period last year, but a 6.5 per cent decrease compared to the previous quarter.

Despite owning just 11 per cent of the market, HCF was responsible for the majority of complaints with 230 grievances lodged against its name. Bupa, meanwhile, which has the lions share of the market received just 174 complaints.

Percentage-wise, this means HCF was responsible for 30.5 per cent of all complaints against health insurers for the last quarter of 2020, while Bupa was responsible for 23.1 per cent. Medibank Private, the country’s second largest private health insurer, claimed 15.8 per cent of complaints.

A spokesperson from HCF acknowledged the increase in complaints about the website and blamed the phone system error for compounding the issue.

“The majority of these referrals centred particularly on service and claims processing issues,” the spokesperson said. “HCF implemented a major upgrade to its IT systems in October 2020. Given the scale and complexity of the system transformation program, some initial teething problems did occur which we have been addressing as quickly as possible.

“At the same time, HCF experienced an unrelated issue with our telephony systems that impacted our call centre waiting times and which unfortunately took some time to resolve.”

The spokesperson said the issues had now been rectified, and all complaints resolved, and apologised for any inconvenience members experienced during the upgrade.

The Ombudsman said the top five consumer complaint issues during last year’s final quarter were:

Membership cancellations
Pre-existing conditions waiting periods,
Delay in benefit payments
Service delays
General treatment benefits

Several health insurers, including QLD Country Health Fund, Police Health and ACA Health Benefits received zero complaints for the 2020 fourth quarter.

IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your financial or legal situation, objectives or needs. That means it’s not financial product or legal advice and shouldn’t be relied upon as if it is. Before making a financial or legal decision, you should work out if the info is appropriate for your situation and get independent, licensed financial services or legal advice.

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