Latest news with #NickStone
Yahoo
2 days ago
- Business
- Yahoo
Bupa fined A$35m for misleading Australians on health claims
Private health insurer Bupa has been fined A$35m ($22.8m) after admitting to misleading or deceptive conduct that led more than 4,000 Australians to forgo claiming hospital treatments they were entitled to. The Australian Competition and Consumer Commission (ACCC) announced the penalty, stating that Bupa had acknowledged breaches in its handling of customer claims. The ACCC revealed that Bupa incorrectly informed policyholders they were not eligible for private health insurance benefits, resulting in some customers paying thousands of dollars for medical treatments that should have been at least partially covered. In some cases, policyholders upgraded to more expensive policies to secure coverage they believed they lacked. ACCC chair Gina Cass-Gottlieb said: 'Consumers purchase private health insurance to provide peace of mind, certainty of coverage and the ability to choose where and when to undertake their procedures. Bupa's conduct denied certain members benefits to which they were entitled to under their private health insurance policies.' She noted that the conduct, spanning across five years, caused harm to consumers, with some delaying, cancelling, or going without treatments they were covered for. Bupa APAC chief executive Nick Stone said: 'Our priority has been to communicate and compensate our affected health insurance customers and providers, along with putting in place measures to help ensure this does not happen again.' The company has already paid A$14.3m to address more than 4,100 affected claims. The misconduct involved two types of insurance claims between May 2018 and August 2023: 'mixed cover claims' and 'uncategorised items.' Mixed cover claims involve treatments partially covered by a customer's policy and partially by the customer, while uncategorised items refer to treatments not assigned to a standard clinical category in Bupa's systems. According to Bupa, mixed coverage claims accounted for less than 0.02% of assessed customers, and uncategorised items represented about 0.004% of claims over the period. The ACCC attributed Bupa's errors to inadequate staff training and unclear instructions for assessing mixed coverage claims, compounded by systems programmed to incorrectly reject both mixed coverage and uncategorised item claims. Cass-Gottlieb said: 'Private health insurance is complex, and consumers should be able to trust their health insurer to assess and pay health insurance claims accurately. Bupa's conduct is very serious and falls well short of what is expected of one of the largest health insurers in Australia. 'Bupa should have invested in the necessary systems, processes and training to prevent this from happening, and address it promptly when it occurred.' The ACCC and Bupa will jointly request a court order for the A$35m penalty and other measures, with the court to determine the appropriateness of the penalty. Bupa began compensating affected members, medical providers, and hospitals prior to the legal action. "Bupa fined A$35m for misleading Australians on health claims" was originally created and published by Life Insurance International, a GlobalData owned brand. The information on this site has been included in good faith for general informational purposes only. It is not intended to amount to advice on which you should rely, and we give no representation, warranty or guarantee, whether express or implied as to its accuracy or completeness. You must obtain professional or specialist advice before taking, or refraining from, any action on the basis of the content on our site. Sign in to access your portfolio
Daily Mail
3 days ago
- Business
- Daily Mail
BREAKING NEWS Bupa forced to pay back $35million to thousands of Australians: What you need to know
One of Australia's biggest health insurers will pay back $35million after thousands of hospital claims were incorrectly rejected. Bupa has admitted to engaging in misleading or deceptive conduct and making false or misleading representations by advising customers they were not entitled to private health insurance benefits for their entire claim, when in fact this was not the case. Bupa APAC CEO Nick Stone has issued an apology and acknowledged that it should 'never have happened.' 'Our priority has been to communicate and compensate our affected health insurance customers and providers, along with putting in place measures to help ensure this does not happen again,' he said in a statement. Bupa has started compensating affected members, medical providers and hospitals, and has paid $14.3million to parties for more than 4,100 affected claims to date.
Yahoo
3 days ago
- Business
- Yahoo
Health insurer fined $35m, misled 4k members
Private health insurer Bupa has been fined $35m after conceding it engaged in misleading or deceptive conduct to talk more than 4000 Australians out of claiming hospital treatments. The Australian Competition and Consumer Commission said in a statement on Monday that Bupa admitted to the breaches after telling customers they were not entitled to private health insurance benefits for their claims, even though they were entitled to make a claim. This left some customers thousands of dollars out of pocket for medical treatments they had to pay for when Bupa should have paid at least part of the bill. The ACCC said some policyholders also upgraded to more expensive policies to ensure they were covered. ACCC chair Gina Cass-Gottlieb said Bupa's conduct affected thousands of members over more than five years and caused harm to consumers, some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies. 'Consumers purchase private health insurance to provide peace of mind, certainty of coverage and the ability to choose where and when to undertake their procedures,' Ms Cass-Gottlieb said. 'Bupa's conduct denied certain members benefits to which they were entitled to under their private health insurance policies.' Bupa APAC chief executive Nick Stone said he was deeply sorry for failing to get things right because customers were saddened by the impacts this has had on them or their families. 'Our priority has been to communicate and compensate our affected health insurance customers and providers, along with putting in place measures to help ensure this does not happen again,' Mr Stone said. Bupa has admitted over a five-year period between May 2018 and August 2023 that it misrepresented members over two separate insurance types – 'mixed cover claims' and 'uncategorised items'. A mixed cover claim includes both treatment that is covered in part by a customer's policy and another part covered by the customer itself. According to Bupa, the private health insurer pays out more than $20m in claims a year as well as six million in-hospital and medical claims, with the mixed coverage claims representing less than 0.02 per cent of assessed customers over the five-year period. Similarly, Bupa says about 0.004 per cent of claims fall under uncategorised items, which include treatments that were not assigned to a standard clinical category in Bupa's claims assessment systems. The ACCC says Bupa's conduct occurred because Bupa staff did not have consistent and clear instructions and training for assessing mixed coverage claims, and its systems were programmed to incorrectly reject mixed coverage and uncategorised item claims. 'Private health insurance is complex, and consumers should be able to trust their health insurer to assess and pay health insurance claims accurately,' Ms Cass-Gottlieb said. 'Bupa's conduct is very serious and falls well short of what is expected of one of the largest health insurers in Australia. Bupa should have invested in the necessary systems, processes and training to prevent this from happening, and address it promptly when it occurred.' The ACCC and Bupa will jointly ask the court to order Bupa to pay a penalty of $35m among other orders. It is a matter for the court to determine whether the penalty and other orders are appropriate. Bupa started compensating affected members, medical providers and hospitals before the start of this legal action and has paid $14.3m for more than 4100 affected claims. Sign in to access your portfolio
News.com.au
3 days ago
- Business
- News.com.au
Bupa fined $35m for ‘misleading or deceptive conduct' impacting 4k Aussies
Private health insurer Bupa has been fined $35m after conceding it engaged in misleading or deceptive conduct to talk more than 4000 Australians out of claiming hospital treatments. The Australian Competition and Consumer Commission said in a statement on Monday that Bupa admitted to the breaches after telling customers they were not entitled to private health insurance benefits for their claims, even though they were entitled to make a claim. This left some customers thousands of dollars out of pocket for medical treatments they had to pay for when Bupa should have paid at least part of the bill. The ACCC said some policyholders also upgraded to more expensive policies to ensure they were covered. ACCC chair Gina Cass-Gottlieb said Bupa's conduct affected thousands of members over more than five years and caused harm to consumers, some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies. 'Consumers purchase private health insurance to provide peace of mind, certainty of coverage and the ability to choose where and when to undertake their procedures,' Ms Cass-Gottlieb said. 'Bupa's conduct denied certain members benefits to which they were entitled to under their private health insurance policies.' Bupa APAC chief executive Nick Stone said he was deeply sorry for failing to get things right because customers were saddened by the impacts this has had on them or their families. 'Our priority has been to communicate and compensate our affected health insurance customers and providers, along with putting in place measures to help ensure this does not happen again,' Mr Stone said. Bupa has admitted over a five-year period between May 2018 and August 2023 that it misrepresented members over two separate insurance types – 'mixed cover claims' and 'uncategorised items'. A mixed cover claim includes both treatment that is covered in part by a customer's policy and another part covered by the customer itself. According to Bupa, the private health insurer pays out more than $20m in claims a year as well as six million in-hospital and medical claims, with the mixed coverage claims representing less than 0.02 per cent of assessed customers over the five-year period. Similarly, Bupa says about 0.004 per cent of claims fall under uncategorised items, which include treatments that were not assigned to a standard clinical category in Bupa's claims assessment systems. The ACCC says Bupa's conduct occurred because Bupa staff did not have consistent and clear instructions and training for assessing mixed coverage claims, and its systems were programmed to incorrectly reject mixed coverage and uncategorised item claims. 'Private health insurance is complex, and consumers should be able to trust their health insurer to assess and pay health insurance claims accurately,' Ms Cass-Gottlieb said. 'Bupa's conduct is very serious and falls well short of what is expected of one of the largest health insurers in Australia. Bupa should have invested in the necessary systems, processes and training to prevent this from happening, and address it promptly when it occurred.' The ACCC and Bupa will jointly ask the court to order Bupa to pay a penalty of $35m among other orders. It is a matter for the court to determine whether the penalty and other orders are appropriate. Bupa started compensating affected members, medical providers and hospitals before the start of this legal action and has paid $14.3m for more than 4100 affected claims.
ABC News
3 days ago
- Business
- ABC News
Private Health insurer Bupa agrees to repay $35 million over incorrectly rejected claims
One of Australia's largest private health insurers has agreed to pay back tens of millions of dollars to thousands of members who had hospital claims incorrectly rejected. Bupa has admitted to engaging in misleading or deceptive conduct and making false or misleading representations by advising members they were not entitled to private health insurance benefits when they were. Bupa reached an agreement with the ACCC on a proposed penalty of $35 million for incorrectly assessing thousands of mixed coverage and uncategorised item claims and related eligibility checks over a five-year period. The company also admitted to engaging in unconscionable conduct relating to its assessment of 388 mixed coverage claims, which included treatment that was covered under a member's private health insurance policy as well as treatment that was not covered under their policy. In a statement, Bupa APAC CEO Nick Stone said the issue should "never have happened" and the company was "deeply sorry for failing to get things right for our customers". Bupa, is Australia's second largest private health insurer and has more than four million members. It has already started compensating affected members, medical providers and hospitals and has so far paid $14.3 million with more than 4,100 affected claims. ACCC Chair Gina Cass-Gottlieb said the consumer watchdog had accepted Bupa's undertaking to continue compensating affected parties. "Bupa's conduct ... caused harm to consumers some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies," Ms Cass-Gottlieb said. Bupa said the errors occurred as a result of inaccurate or unclear instructions, training or guidance which meant Bupa didn't always make correct assessments of claims and eligibility checks or act quickly enough to fix issues. Any customers who believe they may have had a historical claim or eligibility check incorrectly assessed can can visit or call Bupa on 134 135. Australian private health insurance industry's peak representative body, Private Healthcare Australia has been contacted for comment.
