Bupa has been handed a $35 million fine for misleading customers, hospitals and medical providers about its private health insurance benefits.
The health provider was found to have told members they were unable to receive benefits for mixed coverage and uncategorised item claims between May 2018 to August 2023, when they were actually entitled to those benefits.
More than 4100 claims were affected by behaviour the federal court ruled as false, misleading, deceptive, and unconscionable.
A Bupa health insurance sign. (AFR/Natalie Boog)
These claims were mostly for hospital treatments where two or more procedures were performed at the same time.
Some were for claims where only part of the treatment was covered by a member’s policy.
Medical providers and hospitals also did not receive the money they were entitled to.
The Australian Competition and Consumer Commission (ACCC) began court action against the nation’s second-largest private health insurer in June.
Today, the federal court has ordered Bupa to pay $35 million and abide by a five-year injuction prohibting the provider from breaching the rules.
Bupa has paid back most of the affected customers $14.3 million relating to more than 4100 claims.
Claims for hospital treatments were affected by Bupa’s actions (Nine)
ACCC Deputy Chair Catriona Lowe said Bupa’s actions were “extremely serious” as thousands of customers suffered financial harm, pain, suffering and emotional distress.
“Some of Bupa’s members decided to cancel, delay or forego necessary treatment, resulting in potential medical risks or complications, because they were incorrectly told they were not entitled to health insurance benefits,” she said.
“Private health insurance can be a significant expense for consumers, and people rightly expect to receive the level of coverage they pay for.”
Bupa accepted the court decision and apologised to its customers.
“We remain deeply sorry for these errors and have apologised to our affected customers for the impact this has had on them and their families and have taken actions to ensure this doesn’t occur again,” the provider said in a statement.
