Private Health Insurance complaints
Complaints we can look into
Issues we can look into include:
- health insurance benefits
- membership issues such as policy cancellation or premium payments
- application of waiting periods, including pre-existing condition assessments
- incorrect information or advice about your private health insurance
- government incentives, for example if your Lifetime Health Cover loading or Government Rebate has not been correctly applied by your insurer
- contract issues between insurers and hospitals
- complaints about doctors, hospitals and healthcare providers if it involves a private health insurance arrangement such as gap fees
- complaints about Overseas Visitors Health Cover and Overseas Student Health Cover if the insurer is an Australian registered provider.
Complaints we cannot look into include:
- complaints which are not about a private health insurance arrangement
- general insurance such as life insurance, home insurance, or pet insurance
- clinical complaints about the quality of care provided by your doctor, hospital or healthcare provider
- complaints about Overseas Visitors Health Cover and Overseas Student Health Cover if the insurer is not an Australian registered provider.
The Office of the Commonwealth Ombudsman (the Office) protects the interests of private health insurance consumers. We carry out this role in many ways, including:
- resolving complaints through our independent complaint handling service
- identifying underlying problems of private health insurers or health care providers
- providing advice to government and industry about issues affecting consumers in relation to private health insurance
- providing advice and recommendations to government and industry about private health insurance, including the performance of the sector and the nature of complaints
- managing PrivateHealth.gov.au, Australia’s leading source of independent information about private health insurance for consumers.
Is your complaint about one of the things we can’t look into?
We have a list of other ombudsmen and agencies that may help you.
Complaints must be about a health insurance arrangement.
The Office cannot take complaints about the quality of service or treatment provided by a health professional or a hospital. These complaints should be directed to the health care complaints body for your state or territory.
Our service is free to consumers. We are independent and impartial. We do not represent consumers, insurers, hospitals or health services.
We also offer important consumer information and advice on private health insurance through:
- the consumer website PrivateHealth.gov.au
- annual State of the Health Funds Report
- Quarterly Updates
- a range of brochures and factsheets
Before you make a complaint
You should try to resolve the complaint with your private health insurer before contacting us.
How to make a complaint
Contact us if you, or someone you know, has an issue or complaint about a private health insurer.
Visit our publications page for annual report information, facts and advice, brochures and more.
Visit PrivateHealth.gov.au for independent private health insurance information and to compare health insurance policies from every Australian health insurer.
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