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Leaked Documents Expose Health Insurers

In a news exclusive, The Guardian has reported on leaked documents exposing private health insurers rejecting claims involving pre-existing medical conditions without consulting with doctors to confirm the evidence.

According to the Guardian ‘the nation’s biggest health insurers illegally rejected the claims of thousands of sick or injured Australians over seven years’.

The leaked documents were corroborated by a government whistleblower who told The Guardian that he was “going public with this story because it doesn’t seem right that the authorities say nothing to the public after finding health insurers breaking the law”.

The Consumer Health Forum slammed the “disturbing” failures and called on the Government to conduct a review into the handling of pre-existing conditions disputes.

Consumer Health Forum CEO, Leanne Wells, said whatever the rights and wrongs are of individual cases, this story will further shake public confidence in health insurance.

“This issue goes to the accountability and transparency that should be central to the health insurance system and the disclosures should prompt the Government to examine the circumstances surrounding these breaches and provide a report to the public”, Ms Wells said.

Named in the scandal were a number of well-known private health insurers, including NIB, HCF and Bupa.

Responding to questions from The Guardian, ‘the Commonwealth Ombudsman said it was restricted in commenting on individual cases’. But stated that it was “satisfied that we dealt with the matters that were referred to us in accordance with our processes”.

The Consumer Health Forum believes this latest episode underscore the need for a strengthened role for the Commonwealth Ombudsman to monitor health insurance activities.

“Central to the value of health insurance for members is the need for them to have confidence and trust in their health insurance fund,” Ms Wells said.

The news will almost certainly fuel the public’s growing concerns over the value of private health insurance, as an increasing number of Australian families continue to downgrade or drop their coverage – placing greater strain on the public health system.

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