The Private Health Insurance Ombudsman (PHIO) can deal with complaints and enquiries about health insurance. Before contacting the PHIO you should contact the 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.
The PHIO also does not deal with complaints regarding Medicare. Medicare complaints should be directed to their Complaints and Feedback line on 1800 465 717.
How to complain
Step 1: contact the health fund concerned directly and advise them of your complaint.
Step 2: if there no resolution can be achieved through the health fund concerned, contact the PHIO with details of your complaint.
The PHIO provides a complaints hotline on 1300 362 072 and an online complaints form is available on their website.
When lodging a complaint please include details of:
- your complaint
- the name of the health fund concerned
- your name and membership number as well as your contact information
- what you think would resolve the matter for you
- any other information that will help explain your complaint
The content of the Law Handbook is made available as a public service for information purposes only and should not be relied upon as a substitute for legal advice. See Disclaimer for details. For free and confidential legal advice in South Australia call 1300 366 424.