Low Health Insurance Complaints

Health Insurance companies should have a very clear complaints procedure. If a customer is not satisfied with the response of their medical insurance company they have the right to appeal to the financial ombudsman who then arbitrates and gives a final decision by which the insurance company must abide by. Earlier on in the month the Financial Ombudsman Service (FOS) praised the health insurance industry for its low levels of complaints.

According to Melissa Collet from FOS, only 1% of insurance complaints were about private health insurance. On average 70% of complaints about insurance result in the insurance company having to back-track but for the health insurance industry only 31% of decisions result in a change of outcome. This is a remarkable difference and is testament to the fact that the health insurance industry is regulating itself well.

Last year, out of 127,471 new insurance complaint cases only 514 involved disputes over private medical insurance. However there were various areas however that Ms Collect felt needed attention because they featured high on complaints made to Financial Ombudsman Service (FOS):

• Jurisdiction
• pre-authorisation
• experimental treatment
• chronic and acute conditions
• pre-existing conditions

Collet said:

'Consumers get muddled about pre-authorisation. Particularly when they need treatment quickly. Sometimes a misleading impression can be given, over the phone, about what is and is not covered.'

FOS meet regularly with the health insurance industry in order to discuss how they make their decisions and give the industry feedback on the type of complaints that they receive and what they can do to alleviate the situation.