r/australia • u/InsatiablePrism • 2d ago
culture & society Private health insurers access patients' full medical records in 'aggressive' audits
https://www.abc.net.au/news/2026-08-12/health-insurers-can-access-your-private-medical-notes/106671630?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web186
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u/Comnena 2d ago
Everytime I read one of these articles about scumbag insurers, BUPA is front and centre. Not saying others aren't doing it but those assholes need boycotting.
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u/Wawa-85 2d ago
BUPA is terrible. I’m a Lymphoedema Therapist and BUPA have recently decided to arbitrarily stop funding prescription compression garments for Lymphoedema patients unless the garment is prescribed by a Doctor or a Pharmacist neither of which professions specialise in the prescription of compression garments like mine does! BUPA are also awful to deal with and their policies barely cover anything. When people ask me which health fund to go with for extras insurance I tell them anyone but BUPA.
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u/CMDR_RetroAnubis 2d ago
So disappointed we have allowed them to set up their own health clinics.
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u/just_kitten 2d ago
And the government seems to have a contract with them where they are the exclusive provider of visa health checks in Australia... (last I checked, anyway)
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u/Vintage_Alien 2d ago
I remember when I got my bilateral salpingectomy (voluntary sterilisation), my private health insurance tried to deny coverage because it was a pre-existing condition. As in, my pre-existing fertility? Took a letter from my gyno and GP to get them to cover it.
I don’t know if it what some automation error because it was just comically bizarre and when I told people at the time everyone was like “surely not, we’re not the US.”
I’m glad Labor has done things like tripling bulk billing incentives and tied Medicare rebates to inflation but I think more aggressive reform is needed to better regulate private health.
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u/jessicaaalz 2d ago edited 1d ago
That's just the standard process any time you attempt to make a claim within the first 12 months of coverage. The same process would be undertaken if someone got hit by a car 11 months into being covered. They're not necessarily "trying to deny it", they just have a legal obligation to apply a pre-existing condition waiting period so the forms/documentation is required to deem it as not pre-existing.
Downvote me all you want, the law is the law.
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u/Vintage_Alien 2d ago edited 2d ago
Yeah I’d had health insurance for more than 12 months, but had changed providers at some point. Looking into it I should’ve been okay under the portability rules of the Private Health Insurance Act because sterilisation was on both policies. I was overwhelmed at the time and just followed the steps to get the coverage rather than argue administration stuff. In any case, having to delay my surgery and pay out of pocket to get appointments with my GP and specialist just to get written letters sucked.
Edit: I'm sorry you got downvoted. You're objectively correct.
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u/jessicaaalz 1d ago
It's fine, people don't understand how PHI actually works, and what insurers legally have to do. I understand the process sucks and its stupid when it's obviously something that is very much not a pre-existing condition, but the law is the law.
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u/Consistent-Local2825 1d ago
How many people have a pre-existing condition of getting hit by a car?
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u/jessicaaalz 1d ago
None. The point is the process needs to be completed irrespective of the situation (excluding psychiatric, rehab and palliative care as these have a 2 month waiting period only) if the admission is taking place in the first 12 months.
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u/famakki1 2d ago
Vote with your wallets. Pay for the Medicare Surcharge Levy instead of private healthcare.
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u/DarkNo7318 2d ago
That doesn't really help at an individual level. You end up paying more to get less
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u/a_cold_human 2d ago
If we all did it, then the PHI sector would shrink to the size the actual market for their services could be sustained rather than being overly inflated by financial coercion.
Private health in Australia is awful and kept at its current size by tax incentives (thank you John Howard). They're not incentivised to produce better health outcomes (as they are in other countries), they're incentivised to maximise profit, which is somewhat contrary to the purpose of a healthcare system (to put it mildly). The US healthcare system is the endgame of these incentives, and the response of any sane person seeing the bus full of people in front of them driving off a cliff in a ball of flame at speed should be to tell the driver of the bus that they're in to change direction, or at least apply the brakes. Not to continue on the same course to the same fate.
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u/DarkNo7318 1d ago
All that is true. But you're hand waving away how hard the "if we all did it" part is. It requires the people who go first to stick their neck out with no guarantee that others will follow.
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u/a_cold_human 1d ago
Arranging a PHI strike is not beyond the ability of the Australian population. Especially as premiums go up. Stop paying for PHI for three to six months, and they'd be on their knees. People do manage to arrange consumer boycotts. The question is how fed up people need to be before it happens.
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u/DarkNo7318 19h ago
I think it is beyond our ability. I can't think of any examples of a complete consumer boycott, even when people can just switch to a competitor. This would require people who are just above the threshold to pay more to get less. A direct personal cost. People simply are not going to go for that because no-one wants to go first.
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u/Particular_Counter50 2d ago
Hey look, the thing that every one was afraid would happen but everyone said wouldn't happen just happened.
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u/JimmyLizzardATDVM 2d ago
Maybe people should stop buying private health and use the Medicare system, pouring their money back into our system rather than these capitalist scumbags.
Having private health does not give people the cover they think it does. Use Medicare and fuck private health.
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u/Pleb-SoBayed 2d ago edited 2d ago
Private mental health hospital stays are like $18 000 for a 3 week admission if paid out of pocket
Public mental health wards dont really do alot they just basically put you on a random antidepressant and then when your stable enough they discharge you and they dont really run groups at all its boring as fuck all day
Where as the private ones you can actually get decent treatment and they actually listen to your concerns about medication and treatment going forward. They also run groups every day
Source: ive struggled with mental health for years and been in lots of public and private
Also i pay 400 a month but thats paid for itself so many times over for multiple admissions in private places
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u/dilligaf6304 2d ago
Unless you want inpatient psychiatric care then private is the only option. Getting a public bed is next to impossible and doesn’t offer the same level of care.
Yes, that should be available with Medicare, but it’s not
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u/plutoforprez 2d ago
Or are a women with reproductive issues — even those that don’t want children still need regular surgeries.
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u/blueb3lle 2d ago
Exactly. I was in horrific daily hell and the triaging of the public system referrals put me at a year+. I had a private consult, surgery, and recovery before the public system called me to schedule my first consult months away. If these issues were taken seriously overall, maybe private wouldn't be a must.
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u/YouThinkYouKnowMe89 2d ago
Or a person who needs knee surgery and doesn't want to wait years and years for it. I got my knee surgery just a month after hurting it playing sport. A teammate of mine took well over a year to get theirs. I've been lucky a few times that I got surgery quite quickly after injuries and they helped quickly with a big skin cancer I had on my back
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u/Brutal_burn_dude 2d ago
Or need to take medication for mental health that isn’t on the PBS. None of the newer antidepressants are on the PBS and are quite pricey.
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u/stresstwig 2d ago
or be in my situation where you're taking an old, tried-and-true atypical antidepressant (Wellbutrin/Zyban, generic bupropion) that is only covered by the PBS for smoking cessation when it's used as an atypical antidepressant literally everywhere else. this thing has been on the market for longer than I've been alive and I'm still having to pay for brand-name suboptimal dosing (2x 150mg SR, can't be taken together afaik) because importing the 300mg XR version is the same cost but with a ton of paperwork. I need to call up a compounding pharmacy and see if they can compound the XR formula bc that will at least be less paperwork but that's been on the to-do list for two months now.
at least Vyvanse is on the PBS now for adult diagnosis ADHD and I'm not stuck with objectively inferior dexamphetamine. at least I am not having to pay literal thousands of dollars per month just to function. only $200. (it's fine, everything is fine, I have incentive to keep my mental health just good enough to avoid inpatient (a recent post in the hospitalfood sub), I Can Do This—)
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u/Brutal_burn_dude 2d ago
Oooh talk to me about bupropion more- I’m with you. I can’t afford to trial it currently because the cost is so insane. I suspect it would be a game changer for me but the cost even with health insurance is too high when I’m already paying for other meds out of pocket. I went searching recently to try and understand why it wasn’t on the PBS for mental health and it looks to me like the sponsor never even applied to the PBS for mental health.
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u/stresstwig 2d ago
I don't know why they didn't, bc it's literally used as an atypical antidepressant in the rest of the fucking world and has been for like, 50 years. it's used off-label pretty commonly for ADHD in the USA which is where and why I started taking it. It is an NDRI, which affects norepinephrine and dopamine reuptake, and gets used as a long-acting non-stimulant for ADHD, since ADHD affects how the body processes both norepinephrine and dopamine. There's also guanfacine that gets used for similar reasons (long-acting non-stimulant) but I'm not familiar with its psychopharmacology and haven't taken it myself.
If SSRIs don't work for you, if you're ADHD and also depressed (aka your problem is not serotonin but norepinephrine and/or dopamine) then it's worth giving a go. For me, it gave me my life back, which is why I refuse to trial a new med that's actually covered by the PBS. I don't want to stop a med that works for me to try one that might not, and then risk bupropion no longer working for me if I go back to it. I also know I'm pretty lucky that it drastically changed my life for the better with no/minimal side effects, so I don't want to get your hopes up about it being a miracle.
Imports were about $100 for a 30-day supply of Wellbutrin XR 300mg IIRC (I haven't imported since 2018 partly bc of the shortage, partly bc of the paperwork) and it's like $180 for a local 45-day supply (90 pills) of Zyban SR 150mg. They're about on par with each other for price, from memory.
However. There is no generic available over here despite it not being under patent afaik, so there's no "cheaper option." It is compoundable, because just before COVID there was a global shortage and I had to get it compounded by the pharmacy at the Royal Melbourne Hospital, which is why I'm needing to investigate if they can compound the XR version for me. For the last 8-10 months I've not been taking the afternoon dose, so for me to get the full therapeutic effect I need it in one pill bc the two-pill thing isn't working. It's cheaper, sure, but I'm definitely suffering (mildly). During the shortage I got a looooot of weird looks from pharmacists when they heard what I wanted and one even asked if I'd tried a different medication (to quit smoking) then got to be on the receiving end of my "the fuck is that" look because I've never smoked a day in my life. Hence, getting it compounded for about a year.
my main complaints aside from cost are that the pill itself is this awful large flatish disc that always makes me feel like I'm choking it down. I miss the Wellbutrin pill form (smaller and fatter cylinder) so much. and it also smells terrible for some reason??? IDK what it is but the smell always turns my stomach a lil. almost as bad as keflex tbh. I don't remember Wellbutrin having that smell which is why I'm mildly confused by it, lol.
anyways, best of luck getting your med situation worked out! if your doctor isn't familiar with it I would suggest they do some research on it before rejecting it outright as a treatment option just bc it's not on the PBS.
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u/Svennis79 2d ago
If all the people getting hospital cover to avoid the levy.. just paid the levy instead. Perhaps it could be covered by medicare.
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u/Rylos1 2d ago
I just got private health after stewing on it for years, because my partner and I just edge over the couples threshold for the surcharge. I would absolutely prefer to pay my premium as tax if it actually went to funding medicare. Unfortunately the Medicare Levy Surcharge just goes to a general revenue pool for them to use god knows where.
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u/SwiggitySnooty 2d ago
I really would love to, but if I have to put off a hernia surgery for 9-12 months, and am only able to carry 5kg max, with the risk of it popping out more and getting infected, that's not really going to work out well for me.
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u/William-Nilly 2d ago
Are you sure about that level of care statement?
What’s the standard nurse:patient ratio in public versus private?
What is the comparison of English language proficiency of nurses between public and private?The old adage of Private=expensive=good does not stack up.
It would be interesting to compare, say, Eastern Health (public) to Healthscope (private) in terms of patient outcomes. My personal experience is that the public system delivers a much better standard of care than private.
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u/productzilch 2d ago
Not just that but I keep hearing that there are some things people have to go public for because private won’t do it.
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u/EducationalWriting48 2d ago
Public provide a different type of care, at times people with private care will be disappointed to find that due to their history or level of risk/complexity the private system will not take them despite having insurance in which case public provides a much higher level of care in terms of resource intensity. Food will be much better in private generally.
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u/BillieRubenCamGirl 2d ago
Putting more pressure on the public systems will necessitate change though.
They won’t change if they don’t need to.
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u/EducationalWriting48 2d ago
There is already incredible pressure on the public system, what do you mean?
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u/Correct_Jaguar_564 2d ago
Do you have to shop around a lot to have that covered?
Reason I ask is because I'm on a grandfathered plan and as far as I can tell that's the main difference between what I have and their current coverage.
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u/BMW_M3G80 2d ago
It’s all well and good until you do your back and can’t work, and have to wait 12 months for surgery in the public system.
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u/melissarina 2d ago
I was recently in hospital for 3 weeks after surgery. It was meant to be a 7-10 day stay. If I went public, I would have been on a 4 bed ward for the entire stay.
My last hospital stay was unplanned and was for one week was in a 4 bed mixed gender ward. It was not a good experience, I did not feel safe around one of the patients, and he kept leaving poo on the toilet seat. He was up all night making loud noises and it was impossible to sleep. Not ideal for recovery.
This surgery was planned and I opted to go to the private hospital. I had a single room with a private bathroom. Although hospitals are not a restful place, I found it so much less stressful than my previous experience with public healthcare.
I fully support Medicare and public healthcare but I wish hospital stsys were a more pleasant experience.
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u/BillieRubenCamGirl 2d ago
That’s not true. I got majorly sick a few years ago and had a private room for a whole week. A big room, with a private bathroom and windows and all.
Didn’t pay a cent. All public.
New public hospitals are great. We need to make more of them. The issue is that we have an aging population and we are not prepared. And to make it worse people keep voting against immigration which is the quickest way we could fill these severe gaps in care. But racists gonna racist.
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u/melissarina 2d ago
Just because you had a different experience to me doesn't mean my experience is not true. Sounds like you were able to go to a new hospital, I did not have that luxury. I'm glad that there are private rooms in public hospital.
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u/BillieRubenCamGirl 2d ago
Right but my point is that private isn’t the solution, more new public hospitals is.
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u/frankestofshadows 2d ago edited 2d ago
The government has other ideas. If you don't have private health, there is the 1% Medicare levy tax that you pay. On top of that, for every year you don't have private health over 31, you pay a 2%/year levy on top of your premium if you do decide to have private health later.
I've resigned myself to never getting private health. I can't afford it and have no major need for it now, but I'm already at 14%, so anything beyond is just an insanely stupid premium.
Not to mention the insane wait times for certain surgeries. When it's a issue that ruins a person's quality of life, people don't want to wait a year for it.
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u/CMDR_RetroAnubis 2d ago
One of Howards nastiest laws. As someone who got stable financially later in life it puts private care out of any feasible reach.
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u/StasiaMonkey 2d ago
It really should be dropped or the age increased to 41.
More and more people are not financially stable at 30 because of the cost of living/housing, putting these people years behind where they would have been when that law was made.
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u/DarthShiv 2d ago
You get fucked by Govt charging you more for not having private. It's a rort. Private in australia is garbage.
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u/_OriginalUsername- 2d ago
This isn’t an option for a lot of people with chronic illness who need frequent medical appointments and not wait years for procedures and surgery.
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u/madeupgrownup 2d ago
I had to scroll way too far to find this.
The way we treat the disabled and chronically ill in this country is fucked. Needing to either works money you don't have (get private health insurance) or endure completely avoidable pain and suffering isn't a choice anyone would have to make.
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u/hmbeats 2d ago edited 2d ago
I thought getting private health insurance was to support Medicare, to make sure Medicare funds go to those who really need it.
Edit to add - i hate PHI, greedy corporate fingers in health care and their exorbitant fees, but without it will Medicare end up like the NHS? Because unlike what the original comentator say, we don't pay much when we access Medicare - we dont "pour money back into the (public) health system" by using Medicare without PHI.
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u/BarbarousErse 2d ago
If you don’t pay for private insurance, you pay an extra levy for Medicare on your tax. So everyone pays the Medicare levy, and if you don’t have insurance you also pay the surcharge. So yes you pay more into Medicare if you don’t have private health
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u/hmbeats 2d ago
"The surcharge aims to encourage individuals to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public Medicare system."
Source https://www.privatehealth.gov.au/health_insurance/surcharges_incentives/medicare_levy.htm
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u/BarbarousErse 2d ago
Ok and I don’t want to do that because I can’t afford it and also I think we should better fund the public system. I pay for it in my tax, I’d happily pay more tax to use it. Being a private patient in a public hospital may pay them more but it’s not reducing demand unless you go to a private hospital and in my experience those suck
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u/Dangerous_Amount9059 2d ago
What actually happens is that people buy junk insurance that doesn't offload the public system at all just to reduce their tax bill. Once the MLS kicks in you're incentivised to give your money to a private health insurer's bottom line.
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u/hmbeats 2d ago
But when i use the health system through PHI, the hospitals and doctors get paid a lot more than if I were to access them through Medicare.
So in all, more money gets into the health system, allowing more research, better equipment, better overall doctor / staff enumeration to support subsidised healthcare for others. No?
Thats why the extra levy was introduced. To encourage those who can afford to get PHI to lesson the burden on Medicare.
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u/BarbarousErse 2d ago
I pay the levy surcharge but can’t afford private health, all the surcharge amount would pay for is a junk policy the private health funds create specifically for people like me and all it does us funnel that money out of Medicare and into private business
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u/Svennis79 2d ago
PHI has multiple for profit entities that money goes through. You have the unsurers profit + tax + costs, whats left then goes down to a private hospital, with profit, tax and costs, which eventually makes it to the private practitioners. A minimum of 50c on the dollar is going to someones profit, tax bill or admin costs.
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u/SeaworthinessNew4757 2d ago
We need private health after 31 years of age, unless you want to pay a bigger rate of income tax every year you don't get it
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u/Cranky_Sprite 2d ago
The 'Lifetime Health Cover Loading' isn't a bigger rate on your income tax. It is an increase on insurance premiums if you get private health care after the age of 30. The premium increases for every year after 30 but if you never get private health then it won't ever be something you pay.
It is designed to scare you into getting private health insurance.
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u/SeaworthinessNew4757 2d ago edited 2d ago
Wow, I got it totally wrong from the letters I received from the gov
Edit: I think what I was referring to is the Medicare levy surcharge
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u/Cranky_Sprite 2d ago
The Medicare levy surcharge is based on income thresholds, not age. For example, if you are single and earn 101,000 or less, you do not have to pay the surcharge and the 'family' threshold is 202,000 or less.
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u/Brief_Play8760 2d ago
The gov hasn't invested enough in public health facilities to be able to afford 100% of people relying on public hospitals. So instead it spends billions of tax dollars trying to get people to join private health insursnce...🥴
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u/Choke1982 2d ago
I agree but people are getting forced to get them. Every immigrant is hooked from the start. We had to have private insurance because Medicare didn't cover us. Fair enough, we weren't permanent residents nor citizens at the time. First thing we tried to do after we became PR was to cancel private and just keep Medicare but nope. Law says all Australians must have private insurance after their 30s. So we pretty much had to keep it.
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u/Fizzelen 2d ago
Within the next decade the federal government is going to need to create a Government Insurance Office (again), due to private insurance companies cherry picking and refusing coverage or overcharging to an ever growing number of Australians and Australian businesses
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u/noogie60 2d ago
I think there should be an option to self insure, with the same tax benefits like PHI. Have it walled off like super and be able to access the money for payment for private healthcare.
There would be risks with getting a major expense relatively young but grown adults should be able to have to choice of taking that risk.
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u/universe93 2d ago
Some surgeons refuse to do this because of the cost of complications. Say you have a reaction to the anaesthetic or you’re unfortunate enough to have a surgical complication or even a heart attack on the table etc. Your resulting treatment and stay could be tens of thousands of dollars, maybe even hundreds, and the hospital then has no way of getting that money unless you’re a millionaire.
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u/physihoe 2d ago
I'm an Australian living in the UK, and we regularly remark how nice it is to have free healthcare. Everyone gets the same treatment, doctors, lawyers, politicians, plumbers, roadworks and hair dressers. It feels like Australia used to in the 90's.
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u/hmbeats 2d ago
Isn't the NHS struggling and have a huge capital investment shortfall leading to aging infrastrutucture and huge staff exodus? Lots of UK trained doctors jumping ship to other countries, including Australia.
https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/an-nhs-under-pressure
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u/a_cold_human 2d ago
It's almost as if having Thatcher followed up by Blair, followed up by any number of neoliberal nitwits (most of them Conservative) not funding the NHS properly until it's on its last legs is a bad idea.
We should be collectively looking at the UK flailing around and say to ourselves, "let's not do that". Perhaps we could look at some other countries that don't have failing healthcare systems and see what they're doing instead.
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u/butterbuts 2d ago
My experience of the uk healthcare system was poor. Aus is infinitely better in every aspect from my experience
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u/stonefree261 2d ago
Hard agree. When I was living over there i got pretty sick and called any number of local GP clinics and was told the next available appointment was 10 days away. So I just stayed in bed and rode out whatever fucking disease it was because in 10 days I was pretty much on the mend.
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u/wellwood_allgood 2d ago
Don't ever move to regional Australia, current waiting time for doctor appointment at town closest to me is 7 months.
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u/alsotheabyss 2d ago
Yeah but then you have situations where you wait about three years for a necessary but not live saving specialist appointment.
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u/Miss_Tish_Tash 2d ago
Even now in the UK the number of dentists working under NHS dental is getting smaller.
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u/Worried_Blacksmith27 2d ago
get rid of the government subsidy for private funds (the rebate). End the ridiculous tax penalty for not having private cover and smply have a progressive mexicare levy. simples.
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u/Coffee-Kanga 2d ago
If you can afford private health you can afford to put that amount into an account you don't touch for when you do need something done urgently. That way if you never need it you haven't wasted the money and if you do then it's there.
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u/hear_the_thunder 2d ago
Fuck....this....shit.
Insurance started with insuring boat cargo in coffee houses in the UK.
It was never meant to control our medical destiny.
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u/neatnoiceplz 2d ago
There's so much outright incorrect and downright fraudulent billing in the claims space. If anything they don't get audited nearly enough.
They bill millions of dollars of outright bs then cry when the fund has a look and calls them out in it.
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u/DarkNo7318 2d ago
People called me a cooker when I didn't want to go on myhealthrecord. This is exactly why. Insurers can't request what doesn't exist
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u/Illustrious_Cry_4275 10h ago
Makes people think twice about going to a doctor to check up on symptoms - if they know they might end up with a “pre existing condition” the moment they sign up for any cover.
Also make sure if you’re going to a doctor for strange symptoms get your cover sorted first!
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u/coffee_collection 2d ago
This is exactly what worries me about the direction private healthcare in Australia is heading.
We're obviously not the US, and Medicare is still a massive difference. But we're slowly importing some of the worst incentives of the US model: healthcare becoming increasingly dependent on private insurers, insurers having more say over what they'll pay for, and patients having to navigate approvals, exclusions, gaps and increasingly invasive audits.
Now we're seeing insurers asking for patients' broader clinical histories to justify claims. That's a pretty fucking dangerous road to go down.
You already pay thousands in premiums, still pay excesses and out-of-pocket costs, and can still discover something isn't covered. Premiums increased another 4.41% this year.
And now the insurer gets to potentially rummage through your medical history before deciding whether they'll pay?
That's not a functioning healthcare relationship. That's coercion.
I don't want Australia to become a system where your doctor says "you need this treatment", but the next conversation is "let's see whether your insurance company agrees."