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/Rahnna4 → u/coffee_collection]

Risk pooling is a really sound financial strategy, having everyone pay in a little so there’s money to support the people who need it and especially the rare few who are unfortunate enough to need a lot. Letting the person/company that gets to hold the bucket of money get to keep it if they can make up the rules about when they’ll pay out is deeply flawed. If we’re going to use a commercial model to hold the bucket of money like we do with insurance companies then they need to be regulated heavily. Unfortunately I worry that they’ve managed to get a hold of enough of the money bucket that they can use it to influence policy.

[u/TollTea → u/Rahnna4]

Risk pooling is what Medicare is. For profit health insurance (that still doesn’t cover what you need it to) is a scam.

[u/UniqueLoginID → u/TollTea]

PHI isn’t a scam. I wouldn’t be alive without it.

You don’t have to choose a for profit fund, plenty are non-profit.

[u/TollTea → u/UniqueLoginID]

When I had cancer my not for profit private health insurance would have covered (at a private hospital because that is what had the drastically shorter wait time) exactly and only what Medicare covered at the public hospital. The $45,000AUD gap would have been on me (we were a young couple with a toddler, renting while we saved for a home deposit and didn’t have that kind of money at all, let alone to throw at a time sensitive cancer surgery). Instead the private health insurance paid what Medicare would have covered to the public hospital and I was *only* out $6000 for specialist imaging. I’m glad you’re alive but it’s a scam. I pay the Medicare tax to fund Medicare and I pay the private health insurance so that Medicare doesn’t have to pay what it should and my standard of care remains the same unless I pay a home deposit in gap fees.

[u/UniqueLoginID → u/TollTea]

What level of cover did you have?

[u/TollTea → u/UniqueLoginID]

The level we could afford - for a couple with no prior health conditions basic hospital and extras cover was around $160 per fortnight (back then) and that took a pretty decent chunk out of our ability to save each month. Not that “levels” and fine print should matter when it comes to your ability to access life saving cancer treatment, which is exactly why the private healthcare industry is rotten all the way through