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The Private Health Insurance Ombudsman

April 3rd, 2012 0 comments
Private Health Insurance

Health insurance in Australia is managed in a sophisticated manner. While there is Medicare to ensure that all citizens have some form of health coverage, the private health care system is highly developed. This allows people to take advantage of a greater choice of services, and at the same time eases the burden on the Medicare system.

Although the private health care system in Australia is not controlled by the government, it is regulated, and it is also highly subsidized. The interplay of the two systems amounts to a better program for health fund members and streamlines the health care process.

Image by Fotos Gov/Ba

To make sure the private system offers value for its millions of users, the government formed an agency known as the Private Health Insurance Ombudsman. The job of this agency is to act as an independent entity and handle the needs of non-government medical partners including the health funds themselves, private health fund participants, doctors and hospitals.

What Do They Do?

The Private Health Insurance Ombudsman has a multitude of responsibilities requiring an entire agency of employees. They have 5 main functions:

  • They handle complaints about the private health program from funds, doctors, hospitals and patients.
  • They publish consumer information and reports to help consumers make educated decisions about their health funds.
  • They manage a website at, where you can access the information they provide about private health insurance, how it works, what the process it, what it covers, and the different private health funds.
  • They offer advice to health funds and health professionals based on their knowledge and resources.
  • They work together with the government to regulate and maintain a high quality health care system for Australians.

How Can I use Their Services?

There are a variety of ways in which you may utilise the services of the Private Health Insurance Ombudsman. One is to report any complaints you may have about the system or about a particular health fund. Although not a government regulatory organisation, the agency is charged with monitoring the system and giving appropriate information to consumers.

Any feedback you provide helps them compile their information and may in the long term help other consumers to make more informed decisions about their own health care. The Ombudsman may also be able to help fix problems between consumers and their health funds, leading to better health care services for everyone.

Can They Help Me Compare Health Insurance?

Yes. The Private Health Insurance Ombudsman maintains a list of health funds and puts out an annual health fund review in March each year with detailed information on all private health funds. They do not rate the funds or rank them in any order, but they provide everything you need to know about the funds listed systematically.

The goal of putting out the report is to help consumers make appropriate decisions when choosing a health fund. The more the consumer knows, the better decisions they make; the fewer complaints there will therefore be, and the better the system works for all. It is easy to access the report online on the Private Health Insurance Ombudsman web site, and the report is extremely helpful when you’re trying to compare health insurance funds.

Still have questions? Let's talk!

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