Making a complaint

No system is perfect and there is a good chance that at some point during the time you hold private health insurance that something will go wrong.

Your first course of action should be to contact your fund directly and seek redress through them. However, if they are unable or unwilling to assist you, or you feel that you have been given the wrong information, you can make a complaint to the Commonwealth Ombudsman.

The number of complaints made about private health insurance has increased year-on-year in the last couple of years. 4265 complaints were received in 2014-15 which represented a 24% increase on the previous year. Complaints were primarily about the level of rebates paid by funds - what you thought you would receive back isn't what you get back at all or perhaps the treatment you received isn't covered - followed by incorrect information, service issues, membership issues and waiting periods.

When you make a compaint, the Ombudsman will determine how serious the dispute is, and if further investigation is needed, will decide if the fund's initial response was appropriate or whether additional action by the Ombudsman is needed.

To lodge a complaint, go to the Commonwealth Ombudsman and select the Private Health Insurance Ombudsman option.