55 My Battle to Make the Health Insurers Obey the Law Part 11: 15 October 2024

The Table summarises my contacts with Senator Griff in February 2022. 

Details	Length of Communication	How Sent	Date of Response	Length of Response	What Did Response Say?
Letter to Senator Griff dated 7 February 2022	2 pages	Attached to email sent to senator.griff@aph.gov.au  at 5:01 pm on Monday 7 February 2022	8 February 2022	2 pages	Forwarded email from Minister for Health summarising legal obligations of health insurers
Copy of letter dated 7 February 2022 addressed to Junita Lindsay, HCF Complaints Resolution Officer	6 pages	Attached to email sent to senator.griff@aph.gov.au  at 5:01 pm on Monday 7 February 2022	8 February 2022	2 pages	Forwarded email from Minister for Health summarising legal obligations of health insurers
Copy of letter dated 7 February 2022 addressed to Sarah De Sade at Ombudsman	4 pages	Attached to email sent to senator.griff@aph.gov.au  at 5:01 pm on Monday 7 February 2022	8 February 2022	2 pages	Forwarded email from Minister for Health summarising legal obligations of health insurers
Phone call from Senator Griff at 6:52 pm on Tuesday 8 February 2022	2 minutes 25 seconds	Phone call to me from Senator Griff	I answered call from Senator Griff	2 minutes 25 seconds	Senator Griff had received an email from staff of the Minister for Health and would forward it to me
Email from Senator Griff dated 8 February 2022 forwarding	1 line	Email from private email address for Senator Griff sent at 7:22 pm on Tuesday 8 February 2022	I did not reply because I did not receive the email	Zero length	I did not receive the original email
Email received by Senator Griff from Health Minister Greg Hunt	2 pages	Attached to email from private email address for Senator Griff sent at 7:22 pm on Tuesday 8 February 2022	I did not reply because I did not receive the email	Zero length	I did not receive the original email
Email from Senator Griff dated 17 February 2022 forwarding for a second time an email received by him from Health Minister Greg Hunt	2 pages	Email received from private email address for Senator Griff sent at 12:00 noon on Thursday 17 February 2022	I replied at 12:00 noon on Thursday 17 February 2022	2 lines	I acknowledged receipt of the email originally sent to me on 8 February 2022
Email received by Senator Griff from Health Minister Greg Hunt	2 pages	Attached to email from private email address for Senator Griff sent at 12:00 noon on Thursday 17 February 2022	I replied to Senator Griff at 12:38 pm on Thursday 17 February 2022	9 lines	I said HCF refused to identify the reasons why it refused to pay the claims
Email to Senator Griff	9 lines	Email sent to senator.griff@aph.gov.au at 12:38 pm on Thursday 17 February 2022	No response	Zero length	No response

I wrote to Senator Griff on Monday 7 February 2022

Senator Griff rang me on 8 February saying he had received an email from the Health Minister; he sent it to me.

This is the response by Health Minister Greg Hunt and nothing else ever came from him.  I do not believe Health Minister Hunt was untainted by corruption in this shameful sage.

 

Please see advice below, which may also assist with engaging further directly with HCF: ·         Mr Hankin has complained that HCF has paid benefits for some services provided by Lift Cancer Care Services (Lift), but not others. ·         As at 28 January 2022, Lift is a Commonwealth declared hospital with second-tier approval status as a G category hospital (a private hospital that provides episodes of hospital treatment only for periods of not more than 24 hours) until May 2022. ·         The claims submitted to HCF for Ms Redden are for MBS items 24 and 37, which are considered type C procedures in the Private Health Insurance (Benefit Requirement) Rules 2011. o    MBS item 24 is professional attendance by a general practitioner lasting less than 20 minutes o    MBS item 37 is professional attendance by a general practitioner lasting at least 20 minutes. ·         The Rules describe type C procedures as procedures or services that do not normally require hospital treatment. ·         The Rules also set out the minimum default accommodation benefits that private health insurers should pay for hospital treatment, based on the MBS items for the procedure performed, or service provided, by a medical practitioner. ·         Benefits for day‑only accommodation are payable for patients receiving a type C procedure only if certification is provided. ·         Certification must include: o    sufficient information to identify the patient, the certifying medical practitioner and the specific medical procedure being certified o    details of the patient’s medical condition, or the special circumstances relevant to the specific procedure, that the medical practitioner is certifying require it to be performed in a hospital o    a signed statement to the effect that the medical practitioner certifies that it would be contrary to accepted medical practice to provide the procedure unless the patient is given hospital treatment that does not include part of an overnight stay. ·         Insurers have an administrative obligation to check the validity of certification documentation to ensure it meets the requirements as set out in the Rules and the procedure, or service, is covered by a patient’s private health insurance policy. ·         The Rules do not provide for insurers to assert a clinical assessment or judgment of a patient’s medical condition/s or special circumstances certified by a medical practitioner. ·         If an insurer rejects a type C certification, for any reason other than that it fails to meet the requirements prescribed in the Rules, or that the proposed procedure is not covered by the patient’s health insurance policy, the insurer is in breach of the Rules. ·         Claims rejected by HCF, it argues, are because the services provided to Ms Redden were not hospital treatment. ·         The Department of Health is aware of disputes between Lift and HCF about certification, and has and continues to engage with both parties in an attempt to resolve the disputes. ·         More broadly, the Department continues to work with the private health industry sector to influence improved communication and processes, to prevent disputes between parties such as this protracted dispute. ·         While it is appropriate that medical practitioners have clinical autonomy, it is equally important that sufficiently transparent and accountable processes are developed for clinical decision-making, to limit the potential for inappropriate practices and protracted negotiations around payment of benefits. ·         The 2021-22 Budget included a reform measure to address ongoing stakeholder concerns and disputes over what are considered appropriate hospital certification processes in private hospitals: https://www.health.gov.au/sites/default/files/documents/2021/05/private-health-insurance-improving-affordability-and-sustainability-of-private-health-insurance.pdf ·         A key aspect of the measure is the development of a Bill that would seek to expand the authority and functions of the Professional Services Review Agency (PSR), to review potential inappropriate practices by medical practitioners and associated hospitals, when certifying that type C medical treatments, or services, are required to be delivered in hospital. ·         Another key aspect of the reform measure is encouraging medical colleges to create clinical guidelines on what is accepted medical practice in Australia and the circumstances in which admitted hospital treatment (type C certification) is appropriate for services normally provided out of hospital.