43 The Battle to Make the Health Insurers Obey the Law – Part 5: 8 October 2024

Writing to the Commonwealth Ombudsman was a backup strategy.  I googled complaints about private health insurers and the search said the Commonwealth Ombudsman was the government agency to complain to.  I had never heard of the Ombudsman before.  I got contact details for the Ombudsman from the Ombudsman website. I found the Ombudsman Private Health Insurance Complaint Checklist.  This extract is copied without alteration from that document which is unchanged as I write these words in January 2023.

 

“Step 4 – Contact us: • Online (https://www.ombudsman.gov.au) • Telephone (1300 362 072 option four) between 10:30am to 3:00pm Australian Eastern Standard Time Monday to Friday • Email (phi@ombudsman.gov.au) ; or • Post (GPO Box 442, Canberra ACT 2601) 1. Set out clearly and simply what is wrong and what outcome you are seeking. Focus on the core of the issue and summarise the information as best as you can. We ask that your complaint is a maximum of 500 words. 2. List the key dates such as when the problem occurred and details of the contact you have had with your insurer, hospital or doctor about this issue. 3. Provide us with your contact details. The more contact details you provide us with the easier it will be for us to reach you. An email, phone number and postal address is ideal. 4. Make sure your complaint is complete. Depending on the nature of your complaint, you may need to provide your consent or complete additional forms first: • In most cases, we provide the other party an opportunity to respond to the complaint and reach a resolution with you directly. Make sure you provide consent for us to disclose the details of your complaint or provide copies of the documents you give to us. • If your complaint is on behalf of someone else, they will need to provide permission for you to raise this by completing this form. • If you are complaining about a pre-existing condition and want this Office to review the decision, you will need to complete the form Medical Authority Form for us to gain access to your medical records. 5. We aim to provide an initial response to you within 1-2 business days. Occasionally, it may take us longer to respond. If you have submitted your complaint and you have waited more than a week for a response, please contact us again.”

 

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Because the Ombudsman website made no promises (apart from in item 5), it can perhaps claim it never broke any promises.  In my naivety, I did assume that it would genuinely attempt to process my complaint in accordance with the law.  Surely, government agencies exist to ensure that the law is obeyed.

This Table summarises my communications with the Commonwealth Ombudsman in December 2021.

 

Letter Details	Length of Letter	How Sent*	Date of Response	Length of Response	What Did Response Say?
Letter dated 3 December 2021 addressed to Commonwealth Ombudsman	4 pages	Email to ombudsman@ombudsman.gov.au  sent at 12:54 pm on 3 December 2021	(1) Email received at 9:33 am on Wednesday 8 December 2021 from Karina Low, Complaints Officer                   (2) Incorrectly addressed email received at 11:10 am on Wednesday 15 December 2021 from Sarah De Sade, Complaints Officer	(1) 8 lines plus “sign off”                               (2) 11 lines plus “sign off”	(1) We “will not investigate your complaint at this time.  However, if you receive HCF’s response and remain dissatisfied you are welcome to contact us again.”     (2) After using my incorrect Christian name, the email said “I am giving HCF a final opportunity to resolve the matter directly with you.  I have escalated your complaint to a senior staff member of HCF for further review and response.”
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 ombudsman@ombudsman.gov.au sent at 12:54 pm on 3 December 2021	Nil	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 ombudsman@ombudsman.gov.au sent at 12:54 pm on 3 December 2021	Nil	Nil	Nil
Email dated 20 December 2021 to Sarah De Sade	1 page	Email sent at 5:03 pm on Monday 20 December 2021 to  ombudsman@ombudsman.gov.au	Email received from Sarah De Sade at 5:03 pm on Tuesday 21 December 2021	10 lines plus “sign off”	The Ombudsman “will wait until there is an outcome from HCF’s review” before deciding if it will take any action

In effect, the official attitude of the Ombudsman was that it refused to take any action until HCF had finished its bogus “investigation” into what had happened.  The final communication from the Ombudsman on 21 December 2021 told me to “go away”. 

In January 2023, I discovered that the Ombudsman had been aware of the actions of HCF in relation to Lift Cancer Care Services for at least three years in December 2021.  Like the Health Department, the Ombudsman had no intention of doing anything about HCF – or any of the health insurers.  The Ombudsman was “softening me up” as a preliminary to telling me to go away.

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I felt extremely flat after the flurry of activity which had resulted in me writing the letters to HCF and the Ombudsman and compiling the two Tables analysing the Lift claims that had mostly been unpaid but occasionally paid.  Margaret was dying and I had to prepare myself for the imminent funeral.  I tried in vain to think of what I might say at the funeral.  

Although I could not deal with what I might say when that day came, I was able to gather my thoughts about what music I wanted to play at the funeral service.  This is the music list I decided on that evening for the songs I wanted to be played at the funeral.

·       “Blessed We Are”, sung by Peia from the album “Four Great Winds”.

·    “Come Into the Light”, sung by Bliss, from the album “One Hundred Thousand Angels”.

·       “How Can You Mend a Broken Heart”, by the Bee Gees, from the album “Trafalgar”.

·       “Long Time Sun”, sung by Amrit Nam Kaur, from the album “Cradled in Love”.

·       “One Hundred Thousand Angels”, by Bliss, from the album “One Hundred Thousand Angels”.

·       “Time After Time”*, sung by Cyndi Lauper, from the album “She’s So Unusual”.

·       “With You”, sung by Jai Jagdeesh, from the album “I Am Thine”.

* Perhaps unintentionally, “Time After Time” is a song in which the dead lover sings to her living lover, telling him that even though she is dead, she is still watching over him and still cares for him deeply.

 

I stopped trying to think through the details of the funeral at about 6:00 pm when the surgeon was scheduled to commence his surgical list.  I had no idea of Margaret’s position on the list – she might be first or she might be last.  I was physically and mentally exhausted.  I had been awake since 3:00 am and the day was not yet finished.