The Private Health Insurance Ombudsman (PHIO) can deal with complaints and enquiries about health insurance. The PHIO is a division of the Commonwealth Ombudsman's office. Before contacting the PHIO, a person wishing to make a complaint in relation to private health insurance should contact the relevant health fund to let them know about the problem and give them an opportunity to resolve it.

What complaints can be dealt with by the PHIO?

Complaints may be about a private health fund, a broker, a hospital, a medical practitioner, a dentist or other health care practitioner as long as the complaint relates to private health insurance.

What complaints cannot be dealt with by the PHIO?

Complaints regarding the quality of service or treatment provided by a health professional or hospital should be directed to the Health and Community Services Complaints Commissioner (SA).

The PHIO also does not deal with complaints regarding Medicare. Medicare complaints should be directed to the Services Australia- Complaints and Feedback telephone number on 1800 132 468.

How to complain

Step 1: contact the health fund concerned directly and advise them of the complaint.

Step 2: if no resolution can be achieved through the health fund concerned, contact the PHIO with details of the complaint.

The PHIO provides a complaints hotline on 1300 362 072 and an online complaints form is available on the Commonwealth Ombudsman - Private Health Insurance website.

When lodging a complaint, include details of: