Latest news with #medicalpractices
ABC News
03-07-2025
- Business
- ABC News
Bupa customers voice frustrations over denied health insurance claims
Health insurer Bupa has been accused of ongoing unscrupulous behaviour towards its customers amid legal action by the competition watchdog. ABC News has been contacted by patients and medical practices from around the country concerned legitimate claims were denied. Concerns were also raised about poor communication with patients, problematic billing practices, and lack of education among Bupa staff. Earlier this week, the health insurer was fined $35 million by the Australian Competition and Consumer Commission for unlawfully rejecting thousands of claims between May 2018 and August 2023. Bupa rejected claims in full when only part of a procedure was not covered. The insurer admitted to engaging in misleading or deceptive conduct. But Brisbane woman Tara Manning says she believes poor conduct has not stopped after she experienced difficulty with a claim in April 2025 — about 18 months after the period dealt with by the ACCC. She said Bupa tried to reject a claim for laparoscopic surgery to investigate possible ovarian cancer when she went through the pre-surgery eligibility check. The mother-of-two had bronze-level cover that included cover for gynaecological surgery. But because one part of the procedure was deemed "digestive" by the insurer and the government, the claim was initially rejected in full. Facing a $14,000 bill, Ms Manning spent weeks calling and messaging BUPA ahead of her surgery and only had her claim approved hours after she submitted a complaint to the Commonwealth Ombudsman. "It was an incredibly stressful time trying to get a hold of Bupa with wait times on the phone over an hour," she said. "I was told very mixed opinions throughout the whole process. Bupa said it could not comment on individual cases. It said the ACCC case related to errors that occurred because of inaccurate or unclear instructions, training or guidance which meant Bupa did not always make correct assessments of these claims and eligibility checks or act quickly enough to fix these issues. "We are deeply sorry for our failure to get this right in these instances. We know this isn't good enough and we're committed to doing better." Plastic surgery clinics also said their bronze cover patients were repeatedly having problems with Bupa when it came to skin cancer removals. When patients needed a cancer surgically removed, they sometimes required a small skin graft or flap to cover the wound which Bupa deemed to be plastic surgery. Plastic surgery was only covered under silver policies, leaving patients with out-of-pocket expenses of up to $4,500. Jane Griffiths, chief executive officer of peak group Day Hospitals Australia, said private health legislation stated that plastic surgery related to skin surgery was, in fact, covered at bronze level. She said their members regularly experienced this from Bupa. "You can't leave a patient without a closed skin lesion," she said. Do you have a story to share? Email Bupa said this was an industry-wide problem to do with automated billing and patients needed manual overrides. It was raised with the federal government in 2021 but recommendations for reform were yet to be implemented. In response, medical practices told ABC News other insurers had better processes to override the problem, whereas poorly trained Bupa staff would meet requests for overrides with "a blanket no" and the inability to escalate the issue. Many patients were also unaware of the issue and simply paid the gap, the medical practices said. "We are working with hospitals and medical practices to make this process smoother," a Bupa spokesperson said. Bupa also refused to cover more than one surgical billing item a day, while other insurers would cover two or three, Ms Griffiths said. This could be a problem for several types of procedures, including ophthalmology and chemotherapy which involved more than one element, and especially for skin cancers. "If the patient needs to be covered for [multiple cancers], you would have to keep bringing the patient in multiple times which of course is not desirable for the patient or for the surgeon," Ms Griffiths said. Bupa said different health insurers took different approaches to funding same-day procedures. Bupa is Australia's second largest private health insurer. Figures from the Commonwealth Ombudsman show 2024 complaint numbers were largely in proportion to its market share. Queensland man David Anderson said he was left with a $48,000 bill for triple bypass heart surgery in 2022 after Bupa denied his claim. He said the insurer delved into his medical records and discovered what it deemed a "sign" of heart disease and claimed it was a pre-existing condition. That was despite three of his treating doctors signing statutory declarations that he was symptom-free prior to taking out the policy. "I had climbed a mountain in Canada two months prior to diagnosis," he said. Bupa declined to comment on individual cases but said under law those with pre-existing conditions were not covered even if it was discovered after a policy was taken out and the patient was symptom-free. "What private health insurers can cover is limited by private health insurance legislation." Bupa's market power makes it hard for small operators Ms Griffiths said day hospital operators had a lot of difficulties with Bupa compared to other insurers and "to some extent" they were abusing their market power. She said Bupa was difficult to deal with in negotiations for their contracts with private hospitals. "From the feedback I've had from members, a lot of them have difficulty — particularly very small, specialised units," she said. "They have difficulty negotiating a reasonable indexation at the end of each contract." Bupa said its main aim was a sustainable network across Australia. "Bupa has an extensive private hospital network, and our relationships and commercial arrangements with hospital operators are both fair and equitable. "Bupa is working closely with our hospital provider partners reach agreements that balance the needs of hospitals, while keeping health insurance affordable for our customers." The company said it processed about six million hospital and medical claims each year and the overwhelming majority are assessed and paid without issue.
Zawya
30-05-2025
- Business
- Zawya
Why digital health adoption is the catalyst for South Africa's retail health sector expansion?
Amid cautious consumer spending, the Retail trade sales report from Stats SA reveals that retail trade sales in March increased by 2.8%, with sales up compared to the same period in 2024. South Africa's retail health sector is showing signs of growth. The sector experienced an impressive 7.1% growth in March, contributing 0.5 percentage points to overall retail performance. Retail pharmacies and small-to-medium sized medical practices are more than just businesses; they are essential building blocks of South Africa's healthcare infrastructure. Often serving as the first point of contact for patients, these practices are embedded in their communities and vital to delivering preventative care and treating common illnesses. As these frontline providers take on a growing role in communities, they're also uniquely positioned to benefit from the shifts reshaping the industry. Our data at Merchant Capital shows clear signs of momentum in the sector, driven by several key trends that present strong growth opportunities for pharmacies and practices: Growing demand: With a rising number of chronic conditions and a steadily increasing population, the need for accessible primary healthcare is expanding. This presents a clear opportunity for practices looking to scale and serve more patients. Digital health adoption: Electronic health records (EHRs), digital diagnostics, and telemedicine are redefining how care is delivered. While these technologies improve efficiency and patient experience, they require upfront investment and training—areas where access to funding can accelerate adoption. Regulatory compliance: As the regulatory landscape becomes more complex, practices are facing increased administrative and compliance costs. This creates a growing need for financial support to keep pace with evolving standards. Preventative care emphasis: There is a marked shift towards proactive healthcare, with a surge in patient education initiatives and screening programmes. To participate meaningfully, practices must invest in outreach, specialised equipment, and broader service offerings. To capitalise on these trends, access to strategic funding becomes a critical lever for success. For healthcare professionals, the right financial support doesn't just plug budget gaps, it unlocks growth. Whether it's expanding consultation space, investing in diagnostic tools, or implementing AI-powered admin systems, the right Asset-Free Medical Practice funding partner can help practices modernise and meet the needs of today's patients. As South Africa's retail health sector continues to grow, now is the time for small practices and independent pharmacies to act. With the right stock strategy, enhanced customer experience, and tailored working capital solutions, healthcare entrepreneurs are well-positioned to strengthen their offering, serve more patients, and thrive in a transforming industry. All rights reserved. © 2022. Provided by SyndiGate Media Inc. (
Associated Press
06-05-2025
- Health
- Associated Press
Understanding Entity Medical Malpractice Insurance
05/06/2025, Miami , Florida // KISS PR Brand Story PressWire // When we think of medical malpractice insurance, we often imagine individual doctors protecting themselves against legal claims. However, in today's complex healthcare environment, it's not just individual practitioners who face legal risks—medical practices, clinics, and healthcare organisations can also be held liable. That's where entity medical malpractice insurance comes into play. What Is Entity Medical Malpractice Insurance? Entity medical malpractice insurance is a policy designed to protect healthcare organisations, not just individual providers, from malpractice claims. In a healthcare setting, the 'entity' refers to the practice itself—be it a clinic, group practice, day hospital, or specialist centre. Unlike standard professional indemnity policies that cover individual practitioners, entity policies focus on the legal risks and liabilities that the business as a whole might face. These may include claims arising from administrative errors, systemic issues, or vicarious liability for employees or contractors. Why Is It Necessary? With healthcare delivery becoming more team-oriented and business-like, liability is increasingly shared among multiple parties. A mistake made by one staff member—whether it's a nurse, receptionist, or junior doctor—can implicate the entire organisation. For example, consider a claim involving a misfiled patient report that led to delayed treatment. Even if the responsible staff member is covered individually, the clinic itself could still face legal action for failing to have adequate systems in place. Entity malpractice insurance steps in to manage these broader risks. Who Needs It? This type of insurance is relevant for a wide range of healthcare providers, including: General practices Private specialist clinics Medical centres Allied health businesses (like physiotherapy or radiology practices) Day hospitals Cosmetic and aesthetic clinics Even small practices with only a few employees can benefit from entity cover. As soon as a business provides medical services and has a team involved—especially if there's a mix of contractors and employees—the potential for entity-level liability arises. Key Areas of Coverage An entity medical malpractice policy can offer coverage across several areas, such as: Vicarious liability The business can be held responsible for the actions of its employees or contractors, even if it wasn't directly involved in the clinical decision. Corporate responsibility Organisations may face claims for failing to maintain proper protocols, supervise staff, or ensure adequate training—regardless of who delivered the care. Breach of duty by non-clinical staff Errors in scheduling, patient records management, or administrative systems can lead to patient harm. Even if the issue wasn't clinical in nature, the business can still be liable. Brand and reputation protection Some policies include support for crisis management and media handling if a claim becomes public, helping protect the organisation's reputation. Legal defence and settlements The policy typically covers legal costs associated with defending the entity in court, as well as any settlements or judgments made against it. Common Scenarios Where It Applies Here are a few real-world examples that illustrate how entity medical malpractice insurance works: A medical centre is sued after a locum GP misdiagnoses a patient. While the doctor has their own indemnity, the centre is also named in the suit for failing to vet the locum's qualifications. A physiotherapy clinic is held liable after an administrative error results in a patient receiving the wrong treatment plan, causing injury. A cosmetic clinic faces legal action due to inadequate infection control practices, affecting multiple patients. The issue stems from a systemic failure rather than the actions of a single practitioner. How It Differs from Individual Medical Indemnity It's important to distinguish between individual and entity cover. Individual practitioners are typically required to hold their own professional indemnity insurance. This protects them if they are personally sued for malpractice. Entity insurance, on the other hand, addresses the legal responsibilities of the business itself. A single claim can often involve both the practitioner and the organisation. Without entity cover, the business would need to fund its own legal defence and settlements, which could be financially devastating. How Much Cover Is Needed? The level of coverage required depends on various factors, including the size of the business, the number of patients treated, the nature of services provided, and the mix of employees and contractors. Smaller practices may need modest cover, while larger organisations or those performing high-risk procedures might require more comprehensive protection. Conclusion Entity medical malpractice insurance is an essential consideration for any healthcare business. As the legal landscape in medicine continues to evolve, relying solely on individual practitioner indemnity is no longer enough. Practices must think holistically about risk and ensure the business itself is adequately protected. Ultimately, this type of insurance acts as a financial safety net—helping healthcare organisations continue to operate with confidence, even in the face of unexpected legal challenges. Whether you're a solo GP with a receptionist or the director of a specialist clinic, understanding and investing in entity malpractice cover is a proactive step toward long-term sustainability and patient trust. Original Source of the original story >> Understanding Entity Medical Malpractice Insurance
