All I Want for Christmas ... Is to Understand my Private Cover
The AMA, Consumers' Health Forum and Australian Private Hospitals Association have joined forces to launch a consumers checklist on private health insurance.
AMA Federal President, Dr Kerryn Phelps, said 60,000 of the checklists would be printed and distributed to GPs' rooms and doctors' surgeries across Australia.
Consumers' Health Forum Executive Director, Matthew Blackmore, said the checklist recommended that fund members take up a series of issues with their private insurer.
"Does your fund provide you, your doctor and your hospital with 24-hour access to details of your eligibility for a medical service?
"Does your fund provide you with easy-to-read information about waiting periods and about your choice of hospital and doctor?
"Make sure - as the consumer - you have decided what you want and then you should be asking the health fund to provide it," Mr Blackmore said.
Dr Phelps called on the funds to immediately suspend for 12 months the waiting rules for patients with pre-existing illnesses.
She said reports from the Private Health Insurance Ombudsman's office that complaints about waiting periods for pre-existing illnesses had jumped by 177 per cent (in the September quarter of 2000, compared with the same period last year) were proof of widespread confusion over private cover eligibility.
"Some patients have undergone treatment when they thought they were covered - only to find out they owe up to tens of thousands of dollars afterwards,' she said.
Adelaide surgeon, Doug Handley, said he had operated on a female patient with gallstones who had believed she was covered for the procedure by her fund.
"This lady clearly had no previous symptoms or signs of the gallstones but the health fund refused her cover on the grounds that she had a pre-existing illness.
"They maintained that she would have seen signs of the condition if she had undertaken an ultrasound," he said.
Melbourne GP, Dr Raymond Martyres, said the health insurance industry, like the medical profession, should be subject to a duty of care.
"I had to write to a health fund on behalf of a patient after the fund wanted a written guarantee that the patient's broken arm was not a pre-existing illness. Such demands are unnecessary and a waste of everyone's time," he said.
Dr Phelps said if private patients were not happy with their fund they should explore the option of switching funds.
"There has never been a better time to be privately insured. We are encouraging patients to get the very most out of their private health insurance," she said.