Using health cover in public hospitals drives up premiums. Picture istock.
Using health cover in public hospitals drives up premiums. Picture istock.

How public hospitals are ripping off patients

EXCLUSIVE: Public hospitals are gouging health fund members of more than $1.6 billion a year by demanding they use their private cover to pay for what should be free treatment in a public hospital.

And they are employing staff to bully health fund members into using their cover, which is adding around $100 a year to health fund premiums.

To combat the problem Medibank will from November 1 cut rebates for public hospitals in NSW.

The fund has warned its members they could face out of pocket charges from public hospitals if they use their cover for a private room in a public hospital.

Medibank chief customer officer David Koczkar said NSW hospitals are charging 70 per cent more ($300 per night more) for a single room than other states and the charge had been rising at twice the rate for public hospitals in other states over the last five years.

 

Medibank CEO Craig Drummond is taking on NSW public hospitals over charges. Picture: John Feder/The Australian
Medibank CEO Craig Drummond is taking on NSW public hospitals over charges. Picture: John Feder/The Australian

Private Healthcare Australia CEO Dr Rachel David says since 2010 there has been a steep seven per cent per year growth in public hospitals asking people attending their emergency departments to allow their health funds to be billed for their care.

Premiums could fall by up to $92 a year if the practice was stopped, she said.

All patients, even if they are privately insured, are entitled to free care in a public hospital because they pay a Medicare levy that funds their care.

Privately insured patients are entitled to free care in a public hospital.
Privately insured patients are entitled to free care in a public hospital.

Dr David said if a public hospital pressured them to use their health cover fund members should tell the staff they did not want to discuss the matter until they had been treated and then should seek a guarantee they would face no out of pocket expenses for hospital charges, doctors or medical tests.

They should ask whether using their health cover would entitle them to doctor of choice and a private room, she said.

However, health funds are being accused of hypocrisy because many continue to offer junk health fund policies that only cover people in a public hospital.

And the funds fought off government reforms that would have banned junk policies claiming if that happened health fund premiums would rise by 16 per cent.

"Why are they selling public hospital only policies if they don't want to pay out on them?" Australian Health and Hospitals CEO Alison Verhoeven asked.

The two largest health funds BUPA and Medibank claim they do not offer public hospital only products.

Health fund BUPA says many of its members have been forced to pay up to $1,500 in gap fees when they used their health cover in a public hospital when there would have been no charge if they were public patients.

Many privately insured patients who live in the bush have no choice but to use a public hospital because there are no private hospitals where they live and if they are Medibank members they could face out of pocket hospital charges private hospital users won't face under the new policy.

Mr Koczkar said he doubted NSW hospitals would charge Medibank members out of pocket fees as a result of the policy change because no other states did so.