Private Health Insurance Royal Commission. STOP Illegalities, Bullies & Code Switching.

Private Health Insurance Royal Commission. STOP Illegalities, Bullies & Code Switching.

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Do we need a Health Insurance Royal Commission? If you say Yes, please read on. If you say no, you must read on. Our system is infiltrated with ILLEGAL BEHAVIOUR and greed.  

What is your story? Please leave comments at the end. 

We have recently had the Royal Commission into the banks, a Royal Commission is currently happening into Aged Care, and now a Royal Commission is starting into disability.  A Health Insurance Royal Commission surely must be next? (Recent edit: What I suspected, illegal behaviour has finally surfaced. See links at the end)

Today it's me, tomorrow it could be you. 

Check this out (2 million dollar business waste):

To make a difference please sign up, share and/ or ‘chip in’. Comments can be made below. My pledge is to gather the voices of everyone and speak on a united front to advance Australia FAIR, especially in healthcare. Don't lead me, don't follow me, walk shoulder to shoulder.

There is an insurance company that was withholding communication about critical information, feedback and interpretation for years. Senior management has been caught out lying as a cover-up. There have been activities of encouraging and allowing the switching of patient receipt codes for claims. A health fund that does not follow industry peak body findings. Experiences of a staff member refusing to advise of their manager's details. Frustrations with staff unable to provide evidence or justifications for critical points raised. Evidence for manipulation and incompetence +++. [please look at internet links below about other issues] It goes on and on and I am sick of it. There is one health fund I simply don’t trust. Where is Australia's version of Michael Moore, the maker of the movie Sicko. A must watch. Any documentary maker's out there? Any savvy Journalists, one with a moral compass and a backbone? Now is the time to speak up. 

Practitioners have patient's backs, but who has ours? I’d like to think people’s voices do. People’s computer mouse's I hope will scare the insurance elephant in the room into honesty. Unfortunately, authoritative entities seem to have token roles as little was done. [Edit: Illegal activity has now been leaked. Please look at internet links below about other issues] 

The ‘administration’ of Private Health INSURANCE is self-regulated and has very dark corners harbouring cockroaches within the industry. Each industry has them. I've tried to encourage talking and to put everything on the table, warts and all from both sides, invitations for full understanding and mediation. No luck. No routine audits are performed by the government on its administration activities. Only financial checks are done regularly, which clearly shows it is a system focused on monetary motives, not patient welfare. 

Many people are coursed into joining a health fund because of tax reduction incentives, not health reasons. 

Patient complaints have skyrocketed toward record numbers. When I wrote to the PHIO about my 3 separate concerns about code-switching for patient claims, no disciplinary action occurred that I know of. [please look at internet links below about other issues] I understand switching codes for patient claims to be professional malpractice, fraud. Why isn't something being done about this? Is this really allowed? I was particularly surprised that when I sent my damning 80 pages, senate accepted report to the PHIO, the resolutions person was instructed not to read it and send it back. Why? because my case was closed. When I asked why was my case closed, I did not hear back.

As a practitioner I have uncovered:

Top senior management blatant mistruths to cover up facts. Yes, a multi-billion dollar industry is run by lies, smoke and mirrors approach rather than reflecting, learning and processing.  

Code-switching allowed by senior management, for patient receipt claims for one business. This is favouritism and discrimination. This is unequal management.

A code-switching culture that has developed for patient claims, that is being encouraged at the customer service desk level. Really! Yes, really. Code-switching I thought was defined as fraud. 

Health fund management is ignoring repeated requests for information/ interpretation and feedback to help patients. This is keeping practitioners in the dark.

A key health fund staff member is failing to advise of their manager's details. This is lacking transparency and cooperation. 

‘Special conditions’ are being allowed for some practitioners whilst others are ignored. Unequal administration practices.

Insurance projected anti-competitive behaviour which undermines the ethical and moral values of the health industry. We need more focus on patients and practitioners and less on profit-driven practices. 

I have serious concerns when morality and ethics are swept aside for pure profit. How do you feel about a health fund that has invested part of its surplus 2 billion dollars in profit, in the tobacco industry? 

Do we need a Royal Commission into the Private Health Insurance industry? 

My story is just one of many. Wholesome attempts to help vulnerable community members and I got screwed by one health insurance company. I had no idea a health insurance company could be so evil. 

Check this out:

In 2016-2017 complaints to the PHIO rose to 5,750. In 2018, 256,000 people did not renew their health insurance cover. This is telling me there is a growing dissatisfaction within the industry and people are making a noise about it. 

Please share your experience in the comments below. Opening up this conversation is a start to improving the issues. 

Thank you to all those who liked and shared this petition. We are creating Change(.org), one ‘like’ at a time, one conversation at a time, one action at a time. 

Bonus info: Do you know that if you are in health insurance, you pay 3 separate times for the service you receive (4 times if you include Consolidated Revenue). I believe it to be correct that you pay, A) Firstly through your Medicare levy tax. Apparently, the government subsidies for private health insurance premiums cost to over A$6 billion a year. B) Secondly, by paying your insurance premiums and C) Thirdly, by paying the massive gap on the service. There must be a better way. 

Also, a big reason the price of health services is going up, is simply driven by insurance companies. Insurance subsidies allow higher practitioner charges. Higher charges encourage a greater need for insurance. It’s a vicious cycle. The most vulnerable and sick, don’t have health insurance, so they get left out and really start to suffer. It seems this system is not primarily centered on sincerely helping all levels of our community. There is room for improvement.    

It is easy to find holes in the system, they are everywhere. From my experience and observation, insurance is using them unfairly. At times, they are even abusing their position and power. I say live and let live, but I have been severely affected by one health fund, that was the cause, of the demise, of my life's work. Bad faith insurance practices must be stopped. The real conundrum is the less insurance helps people, the more profit they make. I am compelled to speak out.

My suggestion for a solution is to clean up the industry with a call to action. Starting with an inquiry into integrity and transparency to find out what is really happening behind closed doors. This leads us back to....

Do we need a Royal Commission into the Private Health Insurance Industry? 

This is your system, have your say. Please sign up, share on Facebook and/or ‘chip in’ to the cause, if you feel inclined.

Please share your reasons for signing, your comments or your stories below.


Extra reading: 

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