How do I 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.
Private Health Insurance customers can file complaints by phone, the internet, or mail. When filing a complaint by mail, it is important to have a properly constructed letter.
Complaints about Private Health Insurance should be directed to the Private Health Insurance Ombudsman (PHIO) for a faster resolution.
The PHIO exists to assist customers in resolving disputes. It also works with the Government and private health insurers to help improve their services.
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:
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
Make an online complaint here
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.COMPARE & SAVE
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.
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.
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:
Customer service issues
This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.