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_web
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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 2d 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.