Australian Medical Association private health insurance report card

Australian Medical Association president Omar Khorshid said the report aimed to help Australians understand their private health insurance options better.

He said due to the complexity of the private healthcare system it was difficult for most people to navigate their coverage.

The report identified a continuing trend in recent years with exclusionary private health insurance policies continuing to rise, while non-exclusionary policies declined.

It found since 2019, complaints about memberships and benefits have declined while waiting times and services remained steady - only rising slightly.

READ MORE:

There was also a decline in the insured population with hospital treatment cover, with the age groups of 20-39 and 40-59 both recording a decline, while those 60 and above in the same category continued to increase.

The report found member contributions for services varied across the five major private health insurers, Bupa, HFC, Medibank, nib and HBF.

Femoral or inguinal hernia or infantile hydrocele recorded the greatest variance in contributions between providers - at almost 50 per cent.

Alternatively, cataract surgery, colonoscopies, treatment for sleep apnoea and appendicectomies all recorded a variance of less than 10 per cent.

Dr Omar Khorshid said the report found if the insurer's rebate was low, the out-of-pocket cost to their customers could be high, often varying by thousands of dollars.

"The report card reveals that the same doctor performing the same procedure can be paid significantly different rates by each fund," he said.

"This is often the untold story behind patient out-of-pocket costs, despite there being high levels of no gap and known gap billing statistics."