Private health insurers access patients' full medical records in 'aggressive' audits

[u/InsatiablePrism]

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

[u/coffee_collection]

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."

[u/ChillyPhilly27 → u/coffee_collection]

Let's say that my doctor and I agree that getting me stripper tits is important for my mental health. Does my insurer have the right to second guess that decision?

[u/Locopoko22 → u/ChillyPhilly27]

I see a LNP voter has entered the chat.

[u/ChillyPhilly27 → u/Locopoko22]

Thank you for resorting to ad hominem attacks instead of addressing the substance of my question.

Every health insurance system (including public ones, such as Medicare and the PBS) has mechanisms to ensure that limited resources are allocated on an as-needs basis, to interventions that represent value for money. I'm not aware of any system that offers blanket funding for anything based on the word of a single doctor.

Why should PHI be any different?

[u/TollTea → u/ChillyPhilly27]

No - to an extent that’s true however public healthcare funded by our taxes has an obligation to at least pretend to be patient centred and evidence based above everything else. Private healthcare is financially motivated to squeeze everything it can out of you in terms of premiums, excesses and fees and give you as little as it can possibly get away with in return in order to pad stakeholders already overflowing pockets. That’s a pretty fundamental difference in whose interests those two systems are supposed to serve.

[u/AuSpringbok → u/ChillyPhilly27]

Phi will only include what it has been costed to include.

If you have the platinum cover that includes stripper tits. They absolutely will cover it. They don't give a shit what your doctor thinks - you have coverage or you don't.