Bupa, one of Australia's biggest private health insurers, has reached an agreement with the regulator to pay a total penalty of AUD$35 million for denying legitimate claims.
According to a media release from the Australian Competition and Consumer Commission (ACCC), the breaches of Australian Consumer Law by the London headquartered UK firm, affected thousands of consumers over a period of more than five years.
Some Bupa customers, said the release, personally financed expenses for medical treatments that the insurer should have paid. Others, “were exposed to potential medical risks or complications, physical pain and distress as a result of not proceeding with medical treatment.”
The ACCC announcement said that Bupa has admitted to engaging in misleading or deceptive conduct. The release said this consisted of making false representations by advising members they were not entitled to benefits for their entire claim, when this was not the case.
“Bupa’s conduct is very serious and fell well short of what is expected of one of the largest health insurers in Australia,” said Gina Cass-Gottlieb (main picture), the ACCC’s chair. “Bupa should have invested in the necessary systems, processes and training to prevent this from happening, and address it promptly when it occurred.”
Most of the claims impacted were for hospital treatment, where two or more procedures were performed at the same time. The ACCC said that in cases where part of the treatment was covered by a member’s policy and part of the treatment was not covered, Bupa incorrectly rejected the entire claim.
In a statement, Nick Stone, CEO of Bupa APAC said the issue should "never have happened" and the company was "deeply sorry for failing to get things right for our customers".
