Private Health insurer Bupa agrees to repay $35 million over incorrectly rejected claims
One of Australia's largest private health insurers has agreed to pay back tens of millions of dollars to thousands of members who had hospital claims incorrectly rejected.
Bupa has admitted to engaging in misleading or deceptive conduct and making false or misleading representations by advising members they were not entitled to private health insurance benefits when they were.
Bupa reached an agreement with the ACCC on a proposed penalty of $35 million for incorrectly assessing thousands of mixed coverage and uncategorised item claims and related eligibility checks over a five-year period.
The company also admitted to engaging in unconscionable conduct relating to its assessment of 388 mixed coverage claims, which included treatment that was covered under a member's private health insurance policy as well as treatment that was not covered under their policy.
In a statement, Bupa APAC CEO Nick Stone said the issue should "never have happened" and the company was "deeply sorry for failing to get things right for our customers".
Bupa, is Australia's second largest private health insurer and has more than four million members.
It has already started compensating affected members, medical providers and hospitals and has so far paid $14.3 million with more than 4,100 affected claims.
ACCC Chair Gina Cass-Gottlieb said the consumer watchdog had accepted Bupa's undertaking to continue compensating affected parties.
"Bupa's conduct ... caused harm to consumers some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies," Ms Cass-Gottlieb said.
Bupa said the errors occurred as a result of inaccurate or unclear instructions, training or guidance which meant Bupa didn't always make correct assessments of claims and eligibility checks or act quickly enough to fix issues.
Any customers who believe they may have had a historical claim or eligibility check incorrectly assessed can can visit www.bupa.com.au/mixedcoverage, or call Bupa on 134 135.
Australian private health insurance industry's peak representative body, Private Healthcare Australia has been contacted for comment.
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