Handling health insurance complaints

The Private Health Insurance Ombudsman’s Quarterly Bulletin 59 contains some interesting statistics about health insurance complaints: volume, type and by insurer compared to market share.

Your complaints handling procedures should set out in writing:

(a) the procedures and policies for:

  • receiving complaints;
  • investigating complaints;
  • responding to complaints within appropriate time limits;
  • recording information about complaints;
  • identifying and recording systemic issues;

(b) the types of remedies available for resolving complaints; and

(c) internal structures and reporting requirements for complaint handling.

You should provide a copy of the procedures to all relevant staff. A simple and easy-to-use guide to the procedures should also be made available to consumers, either on request or when they want to make a complaint. The information should be placed on your website.

Bright Law have experience in designing complaints and dispute resolution procedures.

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