Earlier this year, Bupa announced a proposal where their customers will qualify for medical gap cover only if treated in a Bupa-contracted facility. This was later curtailed to cover medical gaps for elective and emergency admissions in public hospitals. Besides the reputational impact on the industry, we believe this move conflicts with some fundamental principles of private health insurance.

Our commitment
We understand that cost control and affordability are key concerns in private health insurance but believe that this should not come at the cost of peace of mind and freedom of choice. And we work hard to ensure that it doesn’t, through our below-industry average price rises1; our percentage of medical services being provided with no-gap2; and our refusal to use preferred provider networks for extras services. 

How it matters to our members 
As evidenced by a recent experience from one of our members, ensuring more choice to patients and doctors is at the heart of what private health insurance is supposed to be. 

Here’s his story. 

We recently had occasion for our son to be admitted to hospital for an extended period of time. He was in extreme pain and could not walk. We went to emergency and he was admitted as a public patient. Over the next five days he was administered some serious IV antibiotics and appeared to have improved enough to be discharged and return home. Unfortunately, we were back within 12 hours with his condition worse than when he was discharged.

We were told at the public hospital that if he was readmitted, even after just a short time, he would have a different clinical team. We felt that we had been well looked after in the previous five days and did not want to lose time and knowledge with a new team.

Because we had private health insurance we were able to be admitted under the same team and we could choose our doctor. Though we understood that we would not get a private room as we were in a public hospital, the comfort that we had in selecting our doctor, as well as bringing in our paediatrician and other specialists is unimaginable and we feel we were better able to manage his care.

This became especially important the longer he stayed in hospital. His was a particularly difficult diagnosis, which was only confirmed after four weeks in the hospital and having undergone treatments for a variety of presenting conditions. This meant that we could choose to get care from the best doctors in their field when it mattered most.

Though we could not call it a great experience (!), without having our private health cover we strongly believe that our son would have spent longer in hospital and with less continuity of care.

This opportunity for choice, along with the wonderful work of the public hospital staff looking after him, meant we had more confidence and could focus on what we needed to do as parents to help get him through what was an extraordinarily difficult experience for a child who had just turned four. He’s a real trooper!

Finally, as his diagnosis is a chronic condition (Juvenile Idiopathic Arthritis), we have peace of mind that future medical costs and readmissions will be fully covered, with the team of our choice.
Andrew, NSW (member since 2010)


1Average premium increases by insurer by year, 10 February 2018 - http://health.gov.au/internet/main/publishing.nsf/content/privatehealth-average-premium-round
2AMA, AMA Private Health Insurance Report Card, Pg. 12, 26 March 2018 - https://ama.com.au/system/tdf/documents/AMA%20Private%20Health%20Insurance%20Report%20Card%202018.pdf?file=1&type=node&id=48140