12 June 2018

AMA welcomes Bupa’s about-face on coverage

Health Funds Insurance Patients

The AMA has welcomed a policy backflip by private health insurer Bupa following an intervention by the Private Health Insurance Ombudsman.

Bupa, which is Australia’s largest health insurer, had planned to remove its medical gap scheme coverage for public hospitals and some private operators, prompting an outcry from doctors’ groups and the public.

The insurer has agreed to restore future access to “no gap” schedules for private patients in public hospital emergency departments.

Newly elected AMA President Dr Tony Bartone said both the ombudsman’s announcement and the Bupa response were welcome and very important at a time of significant reform in the private health sector.

“Public hospitals are often the only place people can have their surgery, either because they are in a regional area, because it has the facilities and support they need, or because their choice of surgeon works in a public hospital,” Dr Bartone said.

“This access to public hospitals is an important part of the ‘value’ of private health insurance.”

Bupa Australia CEO Richard Bowden told media the proposal to restrict the medical gap scheme to participating doctors in only Bupa-contracted facilities  had been well-intentioned, but implementing it, particularly in the public hospital environment, “got too hard”.

Dr Bartone said the AMA remained critical that Bupa policy holders would still not be able to use their “no gap” or “known gap” cover in non-Bupa contracted facilities.

“This remains a major concern for the AMA as it means that patients will still be required to ascertain whether their surgeon and their hospital have a contract with Bupa.”