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Private hospital operator Healthscope has announced it’s terminating agreements with many private health insurers in Australia, including Bupa and the 22 health insurers who are represented by the Australian Health Service Alliance (AHSA).
The cut is set to impact 38 private hospitals across Australia.
If new contracts can’t be agreed, millions of Aussies could be faced with an increase in out-of-pocket costs as determined by Healthscope.
Let’s take a closer look at what it means for you if you’re with one of the 31 funds affected by this dispute.
Why is Healthscope ending the contract?
Much of the dispute stems from Healthscope’s decision to charge Bupa and AHSA members an additional up to $100 out-of-pocket fee to access care in their facilities after lengthy negotiations between the parties around costs.
Healthscope claim the fee is necessary to cover costs from members of these funds.
The AHSA claims Healthscope’s requests for more money would have pushed up premiums for customers.
Bupa and the AHSA threatened legal action to stop the fee and have said they will refuse to pay. Healthscope has now cancelled its contracts with these insurers.
When does the Healthscope agreement end?
If your private health policy is with:
Bupa, the impacts come in from February 20, 2025. So if for example you’re scheduled to have surgery in January, the change may not be an issue for you… yet.
Any funds represented by the Australian Health Services Alliance see their agreement end on 4 March 2025.
But… this is a moving situation and when private hospitals have ended contracts with health insurers in the past, the two parties have often come to the agreement before the contract expires.
What if you’re booked-in for surgery at a Healthscope hospital?
If you’re with Bupa or any of the funds who make up the AHSA then speak to your insurer. They’ll be able to advise you of the best course of action.
If Healthscope sees through the cancellation of its agreement with private health insurers, you may be liable for additional costs if you’re treated at a Healthscope hospital after the contracts expire.
“The important thing is not to panic just yet and to feel you need to change your insurance policy or your surgery date,” says Compare Club’s Head of Research Kate Browne.
“There is still time for the two sides to come to an agreement, and we really hope this happens before the contracts expire. Keep a dialogue open with your GP and insurer as there will be a lot of developments between now and February.”
What are the Healthscope hospitals?
From New South Wales to the Northern Territory, Healthscope has a long list of hospitals. You can look up the Healthscope hospitals by state and territory.
Be aware: in some locations, private hospital options are limited, so this may have a big impact for some patients in regional and rural Australia.
Who are the health funds represented by the Australian Health Services Alliance?
The AHSA represents 22 insurers and 30 brands.
These include:
HBF
Australian Unity
Defence Health
GMHBA
Frank Health Insurance
Navy Health
Teachers Health
AIA Health Insurance
CBHS Corporate Health
CBHS Health fund Limited
ACA Health Fund
Doctor’s Health
Emergency Services Health
HCI
Latrobe Health Services
Westfund
HIF
Health Partners
Phoenix Health Fund
Onemedifund
Nurses & Midwives Health
Peoplecare
Queensland Country Health Fund
See-u
Reserve Bank Health Society (RBHS)
TUH
Police Health Limited
Territory Health Fund
Uni Health
Union Health
Bottom line
Time will tell if Healthscope sees through with the cancellation. It’s a wait-and-see situation but one that has big implications for patients and health fund members across Australia.
The three sides may yet find a resolution between now and February and March, but if you’re with an affected fund, it’s worth speaking to them if you’re concerned.
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Disclaimer:
Any health or financial advice is general in nature and does not take into consideration your circumstances. Always check with a financial or health professional before making any decisions.
