42 The Battle to Make the Health Insurers Obey the Law – Part 4: 8 October 2024

These were my thoughts as I wrote my first letter to HCF on 3 December 2021.

Margaret might have been dying, but she would continue receiving the loving care she had been getting from Lift Cancer Care Services while her health permitted.  Why was HCF was refusing to pay for her therapy?  It had to be a mistake and HCF would surely fix it when I pointed it out.

Before writing to HCF on 3December 2121, I googled the HCF contact details and I found nothing on the company website about lodging complaints.  I decided to send the letter to the address from which HCF sent me their “How Wonderful We Are” emails when they did actually pay claims. 

Then I found the HCF Complaint Management Policy.  This is copied without alteration from that Policy on 3 December 2021.

 

GUIDING PRINCIPLES In line with the Standard and HCF’s responsibilities under the Private Health Insurance Code of Conduct, we are committed to the following guiding principles when handling complaints: PEOPLE FOCUS HCF’s complaint handling process is intended to be fair and equitable to all parties. It allows for active involvement by complainants as far as practicable, permitting their views to be heard and taken into account in a balanced, respectful and meaningful way. ACCESSIBLE, VISIBLE AND TRANSPARENT This policy will be available on our website, in our branches and our Head Office. If we discover that you require assistance or support during the process, we will adopt measures to accommodate the assistance and support you require so that you can meaningfully participate in the process. We do not charge a fee for making a complaint. RESPONSIVE We will acknowledge complaints promptly and respond in full in a reasonable timeframe taking into account the urgency of issues raised. We will communicate expected timeframes to you and inform you if we think there may be some delay. OBJECTIVE, FAIR AND EQUITABLE We will review each complaint in an objective and unbiased manner. We will take all reasonable steps to make sure that you are not adversely affected because a complaint was made by you or on your behalf. If a complainant’s behaviour during the process is unreasonable, we will still endeavour to take all reasonable steps to address the valid issues raised in the complaint in a fair and ethical manner.  CONDUCT AND COMMUNICATION We will be helpful, courteous and professional in all our dealings. We will explain the reasons for our decision and any remedy or resolution we consider fair and reasonable in the circumstances. We will provide contact details of the person co-ordinating the response so that you know whom to contact during the process. ACCOUNTABILITY, LEARNING AND PREVENTION There is clear accountability for our complaint management system. We monitor and report information about complaints to gain insight on areas for improvement and issues requiring deeper analysis to prevent recurrence. All staff undertake training on the importance of complaints to HCF and this policy. We undertake periodic reviews and audits of the complaint management system to assess our adherence to this policy, and to evaluate the overall effectiveness and suitability of our complaint management system.

During every aspect of my dealings with HCF over the many months that followed, HCF made no attempt to comply with any aspect of its own Complaint Management Policy.

This Table summarises the correspondence I sent to HCF on Friday 3 December 2021 while Margaret’s life slipped away from her.

 

Letter Details	Length of Letter	How Sent*	Date of Response	Length of Response	What Did Response Say?
Letter dated 3 December 2021 addressed to Customer Support Team HCF	4 pages	Email to service@hcf.com.au sent at 12:51 pm on 3 December 2021	(1) Email received at 5:45 pm on Wednesday 8 December 2021 from Junita Lindsay, Complaint Resolution Officer   (2) Email received at 10:18 am on Monday 13 December 2021 from “The HCF Team”   (3) Email received at 4:10 pm on Monday 20 December 2021 from Junita Lindsay, Complaint Resolution Officer	(1) 7 lines plus “sign off”                   (2) 5 lines plus “sign off”               (3) 7 lines plus “sign off”	(1) We have received your complaint “and we will be investigating this matter further”       (2) A “Complaint Specialist” was investigating my complaint       (3) The Ombudsman has contacted us.  “We are actively investigating this matter”
Table 1: Itemisation of 32 Separate Complaints Made by Margaret Redden Regarding Non Payment of Health Insurance Claims	3 pages	Attached to letter dated 3 December 2021   Sent by email to service@hcf.com.au sent at 12:51 pm on 3 December 2021	No response except for the brief emails responding to my letter	Nil	Nil
Table 2: Itemisation of Claims Accepted by HCF for Identical Services to Those Itemised in Table 1	1 page	Attached to letter dated 3 December 2021   Sent by email to service@hcf.com.au sent at 12:51 pm on 3 December 2021	No response to ME apart from the brief emails sent to me   …  BUT …   HCF took prompt steps to change its systems to prevent any further “accidental” payment of Lift claims	Nil	I had accidentally told HCF it had a “flaw” in its system which sometimes Lift claims to be paid.  HCF acted to stop this

The responses from HCF amounted to asserting “We are investigating”.  This was a deliberate lie.

In reality, HCF knew exactly why the claims had not been paid – HCF had made a deliberate policy decision to ignore the law in relation to Lift Cancer Care Services. 

I am confident there was no investigation carried out at all – apart from a possible inquiry into how some claims had “slipped through the system” and been paid.  Because no further claims were paid until I forced HCF to surrender, I am confident HCF took steps to ensure no claims could be paid in the future.