Working as a patient finance liaison officer (PFLO) in a public hospital I assist visitors to Australia with their claims for health insurance taken out with an Australian private health insurance. Consistently these Australia Private Health Insurance Companies lie to their clients about the cover that they get for their money.
These health insurers say to their clients that the hospital cover is 100% however in the small print of the policy you will find that the cover is actually 100% of the MBS scheduled fee (for services provided) or state rate (which is a facility fee for the bed, nursing care etc whilst a person is in the hospital).
Of note is that Australian public hospitals typically charge more than the state rate.
These visitors also have to serve the same waiting periods as Australian citizens for hospital services and so when they present to hospitals, they are almost guaranteed to be within waits: overseas visitors are usually here on a holiday and so will never be able to serve the 12 month waiting period for hospital cover.
I have had one case (Medibank Private was the insurer) where the staff member I spoke to told me that the visitor “had no right to claim as they were within the first 12 months of taking out their insurance” even though the policy document states that cover starts within 24 hours.
NIB, IMAN (subsidiary of NIB) and HCF are only a few of the companies where OVHC only covers 100% of the inpatient stay in contracted hospitals. As these are always private hospitals who - generally - do not have Emergency Departments, the overseas visitors presenting to an Australian hospital are continuously trapped between a rock and a hard place. For example: in the hospital I work in these patients have a minimum of $1000 out of pocket expenses per night.
I think these practices need to be investigated as IMHO these insurance companies deliberately exploit the very limited knowledge of the Australian Private Health Insurance that overseas visitors have and cause an enormous amount of stress for these visitors once they land in hospital. I have had patients discharging against medical advice because they could not pay for the out of pocket costs and re-present the next day being a lot worse off and requiring admission to ICU, where the costs are 250% of the medical ward admission.
These companies also place a huge burden on the public health system in Australia as hospitals will always provide care first and have to try and recover the expenses made afterwards, which, in most cases result in a total write-off of the invoice as patients will have left Australia and there is no way to retrieve the money owed.
This is yet another way for these for profit private companies to grab the cash and leave the Australian taxpayer to foot the bill for health care for overseas visitors.