00:00So earlier this week, the ACCC announced that between 2018 and 2023, Bupa had been incorrectly
00:09dealing with mixed billing claims. So when you have a surgery, sometimes there can be
00:13a number of items that make up that surgery. And what was happening for patients, particularly
00:18if they had lower cover, was that where the systems said that one item wasn't covered,
00:24it was rejecting the claim in full. The ACCC said that the claims should have been paid
00:28at least in part. And a lot of Bupa customers over recent months would have been getting
00:34refunds because they should have been refunded, refunded their claim at the time.
00:39What are patients telling us about their experiences?
00:43So this ACCC action goes up to the point of 2023. But a patient got in touch with us to
00:49say as recently as April this year, she had bronze level cover for gynaecology in her cover.
00:56She needed to get investigative laparoscopy for a possible ovarian cancer.
01:02It was again a multi-part procedure. There was one item that wasn't covered.
01:07Bupa rejected the claim in full initially at the eligibility check stage.
01:12So with this surgery looming, she made lots of phone calls and contacts with Bupa trying
01:18to get the issue resolved. But it wasn't until hours after she went to the ombudsman that the
01:22claim was approved and would be paid. Now we're also hearing that day hospitals and clinics are
01:28also raising some concerns. Yeah, so a particular problem has emerged around bronze cover patients
01:35who need skin cancers done. Often skin cancer patients might need a skin graft or a flap of
01:41some sort. And what's been happening is Bupa's claims processes have said that these claims would
01:46be denied because only silver patients have plastic surgery cover. But in fact, when you get into the
01:51detail of the law, they are covered because it's a skin cancer treatment. Now Bupa says that this is
01:58an automated billing issue. It just needs a manual override. But clinics told us when they get in touch
02:03with Bupa, they get stonewalled. They can't escalate the issue. The staff don't know what's going on.
02:08Secondly, the other issue is that day hospitals said to us that Bupa will only cover the first most
02:17expensive item. And this means that patients and hospitals have to pick up the bill for the rest.
02:22Now this is compared to other insurers that might cover two or more procedures.
02:27What does Bupa have to say about all of this? Does it have any more complaints than other insurers?
02:32Well, Bupa has apologised regarding the ACCC action. It says it deals with six million
02:39complaints a year, most of them dealt with without issue. When you look at their complaints to the
02:44private health ombudsman, it's roughly on par with their market share, which is about 25%.
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