Most-complained-about health insurance funds

Who doesn’t love to have a whinge about their private health insurance from time to time? Well, some funds attract more complaints than others.

Your health insurance is so much more than just that hefty amount taken from your bank account each month. It’s peace of mind knowing that your most important asset – your health – will be taken care of when the need arises.

But far too often health insurers, and their policies, don’t live up to the promises made. Preferably, you’d like to have this information upfront before choosing an insurer, but online reviews can only tell you so much.

One way to sort the good from the bad is to track the number of complaints made about them, both to the insurers themselves and to the Private Health Insurance Ombudsman (PHIO).

Which is why consumer group CHOICE has done a deep dive into the complaints handling process to find Australia’s most complained about health insurance funds.

A bit about their methodology

To rank funds by complaints, CHOICE couldn’t simply use raw complaint numbers, as this unfairly disadvantages larger funds. For example, Medibank and Bupa recorded the highest number of complaints overall, but they are also the two largest insurers on the market.

Instead, they assigned a ‘complaint rating’ of low, medium or high – with higher ratings meaning the health fund was worse at handling and processing complaints.

The rating is based on the ratio between the number of complaints received to the number of fund members and whether the initial complaint is forwarded to the PHIO. All data is taken from the PHIO quarterly report.

“If a referral (complaint) is taken up by the PHIO for intervention, it’s then considered an ‘investigation’ (dispute),” CHOICE says.

“When we calculate complaint ratings, we give greater weight to investigations because they tend to be more egregious cases.”

Most-complained-about funds

The investigation awarded a ‘high’ complaint rating to three funds: AIA, HIF and St. Lukes Health.

None of those three are in the top 10 health funds in Australia, but AIA and HIF advertise on TV regularly and are growing in popularity.

CHOICE health insurance expert Daniel Graham explains they could not get information on the nature of the complaints or if they were satisfactorily resolved on the consumers’ end, only that the dispute had ended.

“Unfortunately, we don’t have much detailed data on the reason for the complaints for each fund, nor the outcomes of these complaints,” he says

“But the complaint rating is indicative of the quality of a fund’s internal complaints-handling processes, so we think it’s the most useful metric we have to measure a fund’s performance in this area.”

Have you had to make a complaint about your health fund? What was the process like? Let us know in the comments section below.

Also read: Health insurance extras reset on 1 January

Disclaimer: YourLifeChoices is part of Compare Club Media

Written by Brad Lockyer

Brad has deep knowledge of retirement income, including Age Pension and other government entitlements, as well as health, money and lifestyle issues facing older Australians. Keen interests in current affairs, politics, sport and entertainment. Digital media professional with more than 10 years experience in the industry.


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    • I’m not. I recently had a very poor experience with this fund re lack of transparency and ‘the left hand not knowing what the right hand was doing’. I am currently investigating other funds with the view to changing. I have been with St Luke’s for 13 yrs and never needed to make a claim in that time. Recently I had some minor surgery and it came to light how incompetent the staff at St Luke’s are. I did not feel valued as a client at all.

  1. How about a longer list, from worst to least. The only fund I had knowledge of the above three was AIA, so I am right in assuming the other two are not necessarily very active in all states.

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