In particular, the organisation has been receiving some queries about benefits, and how private health insurance funds across the country seem to be either restricting or removing them altogether from their products.
Between April 1 and June 30, PHIO received a total of 822 complaints. This is up from 694 during the same period of time in 2012, representing an increase of 18 per cent. In the previous quarter, 754 complaints were fielded by the organisation.
Included in the quarterly bulletin is a graph that demonstrates which issues were the most complained about by Australians with family health insurance.
The number of people who were having benefit-related problems saw the most dramatic increase, from 203 last year to 242 in the present.
This was followed by people complaining about their health fund memberships (which rose from 117 to 150 during the June quarter) and having a lack of information (which increased from 79 to 127).
Many Australians have a limited understanding of their benefit entitlements when preparing to receive medical treatment.
More specifically, reveals PHIO, people aren't quite sure how benefits are paid for medical bills.
It should be noted that medical accounts and hospital accounts are dealt with separately. This means that a different set of rules apply to each when it comes to what benefits your health insurance provider will pay.
The extent to which your health fund will cover your medical accounts depends on a number of factors. PHIO explains that, for instance, if your doctor consents to using your health insurance provider's gap scheme, you shouldn't be required to pay surprise out-of-pocket costs.
If, on the other hand, your doctor doesn't use this gap scheme, Medicare and your health fund will work together to cover some of your medical costs. You may be required to make up the difference – e.g. pay "the gap" amount – which could be a significant amount of money.
When it comes to hospital accounts, if your hospital cover is adequate for the medical treatment or procedure you are undergoing and the hospital you are staying at "has a contract" with your health insurance provider, the benefits you receive should cover the majority of your health care costs.
For more information, please contact HICA today.