Doctors warn over ‘junk’ health funds

DOCTORS have revealed the best and the worst health funds in a new report card that shows some policies will leave their members with gap fees on half of all medical services.

The Australian Medical Association has warned people to avoid “junk” policies as they look to switch funds in the wake of the $200 premium hike that takes effect today.

The Australian Medical Association has released its annual Private Health Insurance Report card which says the amount health funds pay in benefits can vary widely between states with some health funds providing benefits for cataract surgery that are 20 per cent lower in one state than another.

Payouts for knee replacements are 18 per cent higher in some states than others.

In Queensland Cessnock District Health fund has emerged as the fund most likely to leave members with gap fees, 40 per cent of services attract a gap fee at this fund,

The doctors own health fund Doctors’ Health is the best health fund in Queensland with 94.6 per cent of medical services provided at no gap, followed by Seventh Day Adventist Health fund ACA which provides gap free cover on 94.5 per cent of services, Australian Unity covers 93.6 per cent of services at no gap.

AMA president Dr Michael Gannon said: “There are lots of policies on the market that will not provide the cover that consumers expect when they need it. If people have one of these “junk policies”, the AMA encourages them to make changes to get better cover and better value for money,” Dr Gannon said.

The AMA has also stepped up its fight against attempts by health funds to give patients information on how much doctors charge.

At present patients have no way of comparing doctors’ fees or finding out before a medical appointment whether the doctor will charge a gap fee.

Health funds are trying to provide this information through various websites such as BUPA’s Find a Healthcare Provider.

Medibank is telling GPs which specialists will charge their members gap fees so they can help choose another doctor. In its submission to the Australian Competition and Consumer Commission’s health insurance inquiry the AMA says the sites amount to an attempt by health funds to manage patients care.

Doctors subject to patient reviews in these websites may start avoiding treating high risk cases, the AMA warns.

Health fund premiums will rise by an average of 4.84 per cent from today adding an average $200 a year to the cost of a family policy.