The Private Health Insurance Ombudsman continues to help consumers across Australia

The Private Health Insurance Ombudsman (PHIO) has recently released the latest information surrounding its performance, and the wider state of the industry.

The PHIO is a statutory government agency which is tasked with overseeing the health insurance industry and attempting to resolve any ongoing issues between health funds and consumers.

The release of its latest report sees the PHIO looking back over the last 12 months. The research has flagged up a number of facts and figures which all Australian private health insurance customers are likely to find useful.

As the PHIO notes, "given the continuing pace of change in the [private health insurance] sector, the availability of independent and reliable information to assist consumers to better understand their private health insurance will be increasingly important."

Complaint handling

A big part of the PHIO's remit is to field consumer complaints and follow these up with the applicable health fund. In this regard, the PHIO is found to be performing very well. Eighty-six per cent of respondents who used the service were satisfied with how their complaints were resolved.

Whilst making a complaint is a seldom easy process, consumers can have the utmost confidence in how the PHIO deals with any disputes.

Furthermore, the agency is making a concerted effort to better engage customers and help them deal with any problems that arise between them and their respective health fund. The PHIO launched itself across social media channels in 2014 in efforts to make the lives of those dealing with it that little bit easier.

Ongoing complaint issues

The PHIO finds that are a number of specific types of complaint which continually crop up. They include hospital restrictions and inclusions, cancelation issues, pre-existing condition waiting periods and general service issues. However, there was a decrease in complaints centred on delays in payments. 

Whilst no industry is ever likely to be completely complaint free, consumers can be assured that their private health insurance services are likely to improve thanks to the fact that the PHIO is actively fighting to deal with the issues which attract the most complaints.

Looking ahead

There are a couple of changes to the PHIO happening across 2015 which private health consumers should be aware of. Firstly, as of July 1, the PHIO will be merged with the Commonwealth Ombudsman. 

The change is merely part of streamlining these two similar agencies, and the quality of the work and services that the PHIO offer to health insurance customers will not be reduced as a result.

The PHIO's other long term aim is to address issues with any health funds that currently receive more complaints than their peers. If this is achieved, the result will be less complaints overall, and a more competitive sector from the viewpoint of the customer.

In total, the PHIO dealt with 3,427 complaints in 2013-2014. Whilst that represents an increase of 16 per cent over the previous years figures, the PHIO have stressed that this in no way a marker of an industry-wide trend. The PHIO estimates that there are 10 million health insurance customers in Australia, making the percentage that actually ever need to flag up a complaint incredibly small.

Independent and reliable

Independence and reliability are the two cornerstones the PHIO's policy. Consumers looking to take out a health insurance policy in Australia can be safe in the knowledge that there is a ratified government agency that views the sector completely impartially.

To that end, talking with experts in the field who also reflect unbiased opinions can be critical in finding the right health fund and any subsequent policy. Shopping around for health insurance can become laborious if you bombard yourself with information. For knowledgeable advice from those that really know the sector, call HICA on 1300 44 22 01.