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News Bulletin : ADA News Bulletin November 2011
20 NOVEMBER 2011 Ombudsman highlights SHORTFALLS in PRiVATE HEALTH inSURAnCE national dental update The release of the Private Health Insurance Ombudsman’s (PHIO) Annual Report on 14 October 2011 highlights the shortfalls in private health insurance previously raised by the Australian Dental Association Inc. (ADA). The Annual Report details the PHIO’s activities in relation to its role as private health insurance industry watchdog during 2010/11. For the full report, go to www.phio. org.au and select Annual Reports from the publications menu. COMPLAInTS On THE RISE The 2010/11 Annual Report states that the PHIO received 3,070 complaints during the year – a 17% increase on the 2,618 complaints received the previous year. This marked increase reflects growing dissatisfaction with the way private health insurers (PHI) are treating their members. The main issues raised in complaints were questions on cover levels, fund rule changes and general issues with service. What is particularly concerning to the ADA, dentists and patients alike is the Annual Report’s mention of a complaint relating to one large insurer that “moved some of its major dental treatments into the general dental category, which reduced the benefits members received”. The ability of PHIs to unilaterally alter member’s entitlements to benefits has been one of the key issues repeatedly raised by the ADA in its annual Submission to the Australian Competition and Consumer Commission (ACCC). For this year’s Submission, go to the ADA website at www.ada.org.au and select it from the submissions menu. The President of the ADA, Dr Shane Fryer, responded to the release of the PHIO’s Annual Report by saying that it is pleasing to see that the Ombudsman has finally recognised these concerns in her Report: “[S]ome of the letters about detrimental rule changes that were sent in 2010 did not contain adequate advice about changes to policies. Copies of these letters were not provided to PHIO for review, which meant we [PHIO] were not able to advise funds to include more specific information to assist members in understanding the impact of the changes. This resulted in higher levels of complaints from members of these funds to PHIO”. The ADA still questions whether such practices by the PHIs respect the contractual relationship that exists between PHIs and their members; are adequately competitive and appropriately respect the centrality of the importance of the dentist/patient relationship to deliver health outcomes suitable for patients. Behaviour such as those noted in the Annual Report further highlight the ADA’S concerns. AdA SUbMISSIOn POInTS It is timely to reiterate the ADA’s concerns and suggestions expressed in its submission to the ACCC, which were: • The protection of clinical independence of health providers; • The need for a mutually agreeable code of conduct to define interactions and relationships between PHIs, their members and health professions; • Ensure parties to the insurance contract have a meeting of minds on the elements of the insurance contract with necessary minimum information being required to be included in a ‘Standard Information Statement’ (SIS); • All exclusions, business rules, restrictions and monetary limits for private health insurance products and policies be covered by regulation and require that these are presented in the SIS; and • The creation of universal terms and conditions in PHIs’ documentation. Because of the ADA’s concerns with PHI behaviour and complaints such as those raised in the PHIO Annual report, the ADA has a dedicated specific page on its website covering the issue: www. ada.org.au/private_ health_insurance/essential_questions.aspx. This provides information to assist patients with choosing a PHI that would best cater for their needs. The ADA will continue to advocate that private health insurers provide greater transparency and openness on the details underpinning what benefits health insurance packages will and will not provide. National Dental Update, October 2011. The ADA National Dental Update is a monthly publication distributed to politicians and opinion leaders. Other issues can be viewed at www.ada.org.au “The ability of PHIs to unilaterally alter member’s entitlements to benefits has been one of the key issues repeatedly raised by the AdA”
ADA News Bulletin October 2011
ADA News Bulletin December 2011