Complaints
What can I complain about?
Complaints need to be about private health insurance or a related matter. They can be about a private health fund, a broker, a hospital, a medical practitioner, a dentist or other practitioners (as long as the complaint relates to private health insurance). However, complaints about the quality of service
or treatment provided by a health professional
or a hospital should be directed to the health
care complaints body for your state or territory.
The Ombudsman cannot deal with complaints about
Medicare. Complaints about Medicare should be
directed to the Commonwealth Ombudsman.
Who can make a complaint?
Generally, anyone can make a complaint, as long the complaint is relevant to private health insurance. The objective of the Private Health Insurance Ombudsman is to “protect the interests of people who are covered by private health insurance”.The Ombudsman will look into complaints that concern private health insurance consumers but the office may not investigate complaints of a purely commercial nature that do not have a significant impact on the rights of consumers.
What should I do if I want to make a complaint?
You should first contact your health fund or
the body you are complaining about. They may be
able to resolve your complaint for you.
Then if you are not satisfied, or if you have any questions, please contact us
What information does the Ombudsman need?
When you contact the Ombudsman you should provide
the following information:
• a clear description of your complaint;
• the name of your health fund and your
membership number; and
• what you think would resolve the matter
for you.
The Ombudsman’s staff will let you know
if any other information is needed.
What can happen after I make a complaint?
Many complaints result from misunderstandings.
The Ombudsman’s staff may be able to explain
what has happened and why, and this often solves
the complaint.
Otherwise, the Ombudsman’s staff will contact
your health fund or the body you are complaining
about to get their explanation and any suggestions
they have for fixing the problem.
The Ombudsman will deal with most complaints
by phone, email and fax and most can be settled
quickly.
Where complaints are more complex, the Ombudsman
will write to the health fund or other body, seeking
further information or recommending a certain
course of action.
The Ombudsman’s staff will keep you regularly
informed, usually by telephone and will give you
their name and contact number, in case you need
to contact them.
What if I just want some information about health
insurance?
We can help with information about private health
insurance arrangements if you want to phone, email or contact us by fax.
We also have a number of brochures and publications about private health insurance arrangements such as the
All our brochures and publications are available on our website or
can be provided on request.
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