How To Write A Letter To The Private Health Ombudsman

Many customers who invest in private health insurance are very happy and satisfied with the coverage and customer service they receive from their insurance companies.

However, there are still instances when formal complaints or questions are warranted.

Customers who feel they are unable to solve an insurance issue directly with their company can contact the Private Health Insurance Ombudsman for assistance.

What Is the Private Health Insurance Ombudsman?

The Private Health Insurance Ombudsman (PHIO) is an arm of the Commonwealth Ombudsman office and is completely independent of private health insurers, private and public hospitals, and health service providers.

It serves to protect the interests and address the concerns of private health insurance consumers. PHIO accomplishes this by:

• Assisting customers in resolving disputes

• Identifying underlying problems with private health fund and health care providers

• Providing advice to the government about private healthcare related consumer issues

• Providing information and advice to consumers regarding private health insurance

While PHIO's primary objective is to advocate for private health insurance consumers, it also takes health complaints about health insurance arrangements from health funds, private hospitals, and medical practitioners.

PHIO accepts all consumer complaints related to private health insurance.

Those with complaints about healthcare quality should contact the healthcare complaints body for their state or territory.

PHIO receives consumer complaints in the following formats:

Phone

The office is open 9:00am to 5:00pm Monday to Friday, Australian Eastern Standard Time.

• Complaints: 1300 362 072 (Calls from mobile phones are charged at mobile phone rates)

• Indigenous Line: 1800 060 789

• Norfolk Island: 1800 1354

• Overseas callers +61 2 6276 0111

Online

Make an online complaint here

Post

Commonwealth Ombudsman

GPO Box 442

Canberra ACT 2601

Those looking to make a formal complaint via post will need to compose a Private Health Insurance Ombudsman letter.

The following letters are templates that consumers can modify and send to the PHIO to facilitate their complaint process.

Letter templates

Misleading communications

Customers who feel that they have been misled by a private insurance company should complete this template.

It helps consumers lodge a complaint for misleading written and oral communications.

This is particularly relevant for customers who feel that their health insurance company gave incorrect advice, failed to keep promises, or provided incorrect information.

As it is illegal for any business to make a false claim or misleading statement, those filing a Misleading Communications complaint don't necessarily need to be customers of the company they are complaining about.

Benefits/Level of cover

If a customer has a complaint that is specifically related to their benefits, he or she should complete the Benefits/Level of Cover template.

While misstatements about benefits are also covered under Misleading Statements, it is important to differentiate that the customer was misled about benefits or their expected level of cover.

Membership issues

The Membership Issues template is for private health insurance customers who feel their rights have been violated in regards to their health fund, an improper cancellation, a denied refund, or the inability to obtain a clearance certificate about benefits or their expected level of cover.

Service issues

Private Health Insurance customers who feel they have been subject to grossly and neglectfully unacceptable service by their provider should complete the Service Issues template.

Examples of service issues include:

• Administrative delays

• Customer service issues

Related Article

Guide to the Private Health Insurance Rebate

Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

Meet our health insurance expert, Chris Stanley

Chris's top health insurance tips

• 1

  Australia’s public health system is world-class, but wait times for public hospitals can be long, inconvenient - and leave you living in constant pain while you wait.

• 2

  An appropriate private health insurance policy can speed up your surgery, relieving your pain sooner.

• 3

  Family health cover means your children are covered under the same policy as you.

• 4

  Many health insurance policies come with a 12-month waiting period for pregnancy-related cover, so it’s a good idea to get a family policy organized well before starting your family. This means your child will be covered from birth until at least their early twenties (depending on which health fund you select).