8th Jun 2018

Bupa softens stance on new exclusions

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Bupa’s policy ‘detrimental’
Olga Galacho

The nation’s biggest private health insurer, Bupa, has caved in to criticism from the Commonwealth Ombudsman over hospital policies labelled as detrimental to its members.

Among the changes Bupa was contemplating introducing on 1 July 2018 was removing restricted benefits knee and hip replacements, cataract surgery and obesity-related procedures.

More than 720,000 policyholders would be affected by the restrictions. Around 70 per cent of YourLifeChoices members have private health insurance.

The insurer will now give policyholders until 1 September 2018 to upgrade their level of cover so that they can continue to receive the benefits they have previously come to expect. Policyholders who remain on the basic to mid cover will not receive payments for a raft of procedures.



In a case study (see below) the Ombudsman’s report detailed how a person with a basic or mid-level Bupa policy could receive up to $10,000 in rebates for having a hip replaced in a private hospital. But the changes Bupa wanted to introduce would see that patient having to pay for the entire $25,000 procedure, with no rebate available.

The Ombudsman also reported that Bupa had failed to communicate a number of changes it was introducing clearly. The insurer has since admitted it could have made its communication more transparent.

In a 21-page report, the Ombudsman listed several criticisms of Bupa’s move to save costs by reducing benefits for policyholders.

“The first is policy restrictions becoming exclusions on Bupa’s basic and mid-level hospital policies,” the Ombudsman’s report said.

“The second is alterations that Bupa has made to its medical gap scheme affecting non-contracted hospital and public hospital admissions.

“In summary, the change (to exclude rather than pay partial benefits towards a list of services on its basic and mid-level hospital policies) removes an entire benefit from payment, including the hospital accommodation, prosthesis, medical gaps and other benefits previously eligible for benefit.”

From next month, Bupa had also planned to stop paying doctors above the Medicare Benefit Schedule or the gap benefit for policyholders choosing to be private patients in public hospitals or attending non-contracted facilities.

It will now pay the gap benefit only if the doctor and hospital performing the procedure has a written agreement with Bupa.

The case before the Ombudsman was driven by an official complaint from Health Minister Greg Hunt and just weeks after the insurer increased premiums by 3.9 per cent.

As reported by The Australian late last week after the Ombudsman’s report was released, Bupa Australia chief executive Richard Bowden admitted the insurer “had come to realise its members valued having a choice of doctor in public hospitals, which in some areas may be the only available hospital”.

The insurer will now roll out a modified scheme for public hospitals from 1 August, according to information on its website.

“Members with a participating doctor face no greater than $500 in out-of-pocket costs for pre-booked admissions, while any emergency treatment will be fully covered.”

Hip replacement case study
A consumer holding Bupa basic or mid-level hospital cover is currently partially covered for treatment in a private hospital for a hip replacement.

Up until 1 July 2018 they are covered for the surgeon’s fee, anaesthetic, prosthesis, pathology and other medical services to the same level as a top level hospital cover. For hospital accommodation and theatre charges, they receive a restricted or “minimum default” benefit of between $277 and $394 per day. The consumer is required to pay the balance of the daily hospital accommodation charges and the theatre fee, which varies depending on the treatment and facility.

Under the current policy, a consumer would expect to receive approximately half the cost back on a $25,000 hip replacement surgery, because a standard hip prosthesis costs approximately $10,000 and Bupa also contributes a significant amount of the costs of accommodation and doctor charges.

From 1 July 2018 this consumer will receive no benefits from Bupa for hip replacement surgery. If the consumer proceeds with treatment in a private facility they will pay the entire costs of approximately $25,000.

If the consumer opts to use the public system they will face a waiting list of up to three years for hip replacement surgery depending on where they reside and their medical status. If they upgrade to a higher health insurance policy after 1 July 2018 to avoid the wait time in the public system, a 12-month waiting period will apply as it would be considered a pre-existing condition.

Were you made aware that previous health insurance benefits would no longer apply? Do you intend to upgrade your cover to obtain the same benefits you used to enjoy? Will you look around for a better private health insurance policy?

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COMMENTS

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MICK
11th Jun 2018
10:22am
Not sure why anybody bothers with health insurance unless they are chronically ill. A sure fire way to reach poverty.
VeryCaringBigBear
11th Jun 2018
1:39pm
Life is too short for me to waste joining the public queues.
Kathleen
12th Jun 2018
12:04pm
We have private cover which is a choice we make because it is like insuring your car and your home only to us even more important.
With so many wealthy people using the public system the waiting lists are often long. Until public hospitals are for people who really need them we will continue to pay the private cover. Not Bupa though!
I know people who don’t blink at paying $31,000 for rates but won’t pay for private cover and wait for the free hospitals. I also know others who have money for all kinds of luxuries and trips but wait for the public system.
So, we need to pay for private cover because there is no means test on the public hospitals and the waiting lists are very long.
Rae
11th Jun 2018
10:48am
We really need to shut down the health insurance industry and funnel all the billions in subsidies into building hospitals. Also renationalise the gambling industry especially the lotteries set up to fund hospitals.
All the medical levy money needs to be going to the health departments.
Administration could be simplified and costs cut if we had a proper universal public health system instead of this dog's breakfast set up for the carpetbaggers like Bupa.

Doubling the population without providing double the hospitals was stupid.
TREBOR
11th Jun 2018
10:52am
Someone commented on the Opera House Lottery yesterday.... it used to work - then some jerk spotted a business opportunity.

Privatisation has yet to show dividends to the general public from whom the 'business' was bought, without their approval.
Jennie
11th Jun 2018
12:59pm
Hmm. This is why I have a not-for-profit private health fund. I was able to have back surgery with a 7 day wait instead of 2 years wait for the public hospital. As I was in severe pain I couldn't wait that long. I also can't take most pain meds. Also a two year wait would have further damaged my problem to the extent that the surgery couldn't have been completely successful.

I agree that for-profit health funds are unethical as are for-profit nursing homes and child care centres.

I also admit that I am very fortunate to be able to afford private health cover plus the large gaps that can occur. I guess it's about prioritising one's expenses - if you can...
Rae
11th Jun 2018
1:55pm
Jennie nobody would need private health insurance if the public system was fixed. You're not for profit fund costs millions to run and that isn't going to the health system. It's data shuffling.

In fact if the health system was universal and the data shuffling minimised you could have your operation promptly without needing insurance and gap fees etc.

The system doesn't work because of the two pronged nature of it all.

Making excuses to justify health insurance isn't necessary. I have not for profit too but that $2500 or so a year I pay for nothing so far would have been better spent on new hospitals instead of a fancy office and computer operators.
Jennie
11th Jun 2018
2:48pm
In a perfect world the health system could be fixed, I agree.

You only have to look at the crisis in the free National Health System in the UK to realise that bureaucracy cripples the service providers plus the overuse by "patients" who think "free" means entitlement.
There is a wonderful example of an NHS "patient" on a student visa from overseas who complained that the free condoms she was given at a GP practice were i. Not enough. And ii. Not coloured!

There has to be ethical behaviour from all involved parties for a totally public health system to flourish.
Rae
11th Jun 2018
4:37pm
Yes Jennie and that's why the small co-payment was a good idea.

Having to pay a certain fee helps prevent over usage without real need.

Ethical behaviour would sure be grand.
Jennie
11th Jun 2018
11:09pm
Yes Rae I agree.
Kathleen
12th Jun 2018
12:08pm
It does not have to be BUPA! There are others that are reasonable and pay out well. We have such a one!
Means test the public system which would help alleviate the waits and mean that pensioners don’t have to pay private cover.
People have a right to choose but also if you can afford to pay at least pay something then do so and ease the burden on the public system.
KSS
11th Jun 2018
3:29pm
Bupa is not the only fund to be removing previously covered conditions or reducing the level of cover. Is the Ombudsman going to investigate all insurance policies? And if he does what is going to change. Seems to me BUPA is still going to make the changes they want just three months later than planned!
sunnyOz
11th Jun 2018
10:58pm
Agree KSS - I am sick and tired of paying my insurance, then the company bumping a procedure into a higher level policy. The way things are going, the only cover you will get on a basic hospital plan will be the removal of a splinter - but you will then have to pay for the band aid. Bupa is not the only fund winding out this predatory cover, pushing and forcing people to pay more for less.
George
11th Jun 2018
11:09pm
Agree, KSS, this is clearly a scam industry. They are not bearing the Risk - something Insurance is meant to cover, if they only pay 40% ($10K) of the total cost ($25K).
Also, what a pathetic response from the Ombudsman, simply allowing 3 more months to continue with implementing the scam! The scheme should be shut down.
Raphael
11th Jun 2018
9:29pm
Oh the joys of socialized medicine
You reap what you sow
The public health system is a failure . It has resulted in cost of medical health provision going through the roof
And so private insurance premiums have to increase as well
Kathleen
12th Jun 2018
12:12pm
It is not socialised but rather used by many wealthy people who could afford to pay. Choice is important but it is immoral to line up for the free hospital because you think it is a right when someone else is waiting with no means to pay in great pain for a long time.
Pay something if you can to alleviate the waits!
Raphael
12th Jun 2018
8:45pm
The wealthy have paid more tax so that medicine is socialized . Why can’t they use it , it’s for everyone
Your sort of thinking is so warped
JoJozep
12th Jun 2018
8:51am
So where is the pathetic health minister hiding in all this health fiasco? The silence of the minister, with Scotty staring him down to cut, cut, any expenditure on health in the stuffed up health system is deafening. Why has Bupa been allowed to put profits ahead of client needs?.

Want more of the same then vote LNP again. Have you noticed politicians are hardly ever sick? The taxpayer funds their welfare. By cutting Medicare, then privatizing it , the government cleverly cut costs, and gave their mates a real opportunity to start private insurance companies in competition, in other words, shifting a public responsibility for health onto very profitable and uncontrolled private enterprise. (Same thing with energy companies by the way, even privatizing overseas detention centers and a raft of other "good" benefits that flow from the private sector- Ha ha ha!)

Come on suckers, you have only yourselves to blame, The LIBS hide behind "free enterprise" read "free to rape the taxpayer" because they naively believe good things will tickle down from the top, (that's what thy're trying to convince the public of).

What utter bullsh*t. As if, if you're a CEO being paid millions to maximize profits, you're going to pass on to the public any profit by way of reduced premiums or providing better or additional services. The two are directly opposing forces. More profit means more handsome dividends and pay increases for the board members and CEO. It's really a trickle up effect, not down. The private companies even employ "sweepers" to sweep up any left over crumbs- it's clever accounting man. For this privilege of raping the tax system, the companies are allowed to minimize their taxes, why can't you or I be allowed to miniseries our taxes to zero in many cases? Is it really a case of the rich getting richer and the masses getting poorer? The answer at present is YES.

So again, lying LNP bullsh*t artists Greg and Scotty should be sacked for telling us lies and unsubstantiated claims of benefits that don't materialize. Liars, liars liars, shame on you and a pox on your house. To the idiots out there who vote them in, you get what you deserve, so stop whinging when nothing from this government happens. Can't you see what's really happening?
Kathleen
12th Jun 2018
12:15pm
I already have a better private cover. Years ago we were with BUPA but have changed twice since then. Shop around. One does free day surgery for example. Every year have a look to see if you have the best deal.
Raphael
12th Jun 2018
9:04pm
Thanks to the 30% rebate paid for by taxpayers
Even the Medicare levy (tax) requires high earners to pay more so that everyone can get medical care for free
Retired
12th Jun 2018
1:09pm
My answers to your important questions are:
1. Were you made aware that previous health insurance benefits would no longer apply?. No I was not made aware of such changes
2. Do you intend to upgrade your cover to obtain the same benefits you used to enjoy?. My budget already bleeding for the high cost of private insurance and it will be a financial killer to upgrade.
3. Will you look around for a better private health insurance policy?. Yes I am shopping around for a better deal...….
Retired
12th Jun 2018
1:09pm
My answers to your important questions are:
1. Were you made aware that previous health insurance benefits would no longer apply?. No I was not made aware of such changes
2. Do you intend to upgrade your cover to obtain the same benefits you used to enjoy?. My budget already bleeding for the high cost of private insurance and it will be a financial killer to upgrade.
3. Will you look around for a better private health insurance policy?. Yes I am shopping around for a better deal...….


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