Ambulance cover complaints have more than doubled in 10 years with many patients being stung for up to $5000 for transfers between hospitals, the Commonwealth Ombudsman’s office revealed yesterday.
In a bulletin on health insurance grievances, the office said that overall, the number of complaints was normalising, falling to 940 between October and December from 1222 in the previous quarter.
The decline of 23 per cent was the third quarterly fall from this year’s peak of more than 1410 complaints in the March quarter.
However, the office said that complaints about ambulance cover in insurance policies were rising largely because patients were unaware that sometimes they were liable for transport between hospitals.
“For example, if a small regional hospital admits a patient who arrives by emergency ambulance only to transfer them to a larger metropolitan hospital, then an ambulance account is usually paid for by the ‘losing’ hospital that couldn’t treat the patient,” the office said.
“If, however, the losing hospital doesn’t formally admit the patient and instead treats them as an outpatient, they can avoid paying the ambulance account because they no longer consider it a ‘hospital to hospital’ transfer. If a hospital chooses not to admit a patient and instead books a second ambulance to send them to another hospital, the ambulance bill becomes the responsibility of the patient to pay.”
The office sounded a warning for patients to check their health insurance company’s level of ambulance cover, because most policies do not extend to transfers or to non-emergency transport.
“In some instances, consumers are incurring costs of up to $5000 when they are treated on an outpatient basis by a local hospital which then transfers them to another hospital,” according to the bulletin.
“Although there are not many instances of this type of failure in the system occurring, for the unlucky few, the out-of-pocket costs can be considerable.’’
The office said it would discuss its concerns over ambulance cover complaints with public hospitals, ambulance providers and health insurers.
More information about the nature of complaints received in the December quarter can be found here.
If you cannot resolve a dispute about your health insurance, call the Ombudsman’s Office on 1300 737 299 or send an email to firstname.lastname@example.org.
Have you ever been left footing the bill for an ambulance trip? Does your health insurance have you fully covered for ambulance trips?