63 My Battle to Make the Health Insurers Obey the Law Part 16: 21 October 2024

My first letter to the ACC was sent by Express Post on Tuesday 22 March.  It had to go by ordinary mail because I could not find an email address for the ACC.  I mailed it to a Post Office Box shown by a Google search.  I summarised what the letter was about using the words - “Repeated False and Misleading Conduct and Probable Cartel Behaviour by Private Health Insurance Funds”. 

I was certain that the health insurers had illegally engaged in false and misleading conduct because of the false claims’ history.  Cartel behaviour occurs when companies agree among themselves to break the law.  This is also illegal.  I believe that when HCF, NIB and Teachers’ Health refused to pay claims for treatments provided by Lift, this was probably because the three companies were engaging in cartel behaviour.

I highlighted these topics because two principal concerns of the ACCC are stamping out false and misleading corporate behaviour and stamping out corporate cartel behaviour.  I knew that if I wanted to involve the ACCC, I had to make it clear that the matters I was complaining about, were clearly within the jurisdiction of the ACCC.

This is a summary of my communications with the ACCC in March 2022.  

Letter Details	Length of Correspondence	How Sent	Date of Response	Length of Response	What Did Response Say?
Letter dated 22 March 2022	12 pages	Sent by Express Post to Executive General Manager Australian Competition and Consumer Commission GPO Box 3131 Canberra ACT 2601	Email from ACC received 19 April 2022	1 page	ACCC had established an “investigation team” to “consider your complaint”.  We “have read your very helpful letter”.  ACCC wanted to have a formal phone call with me and Margaret.
Document summarising Relevant Legal Obligations Binding Health Insurers	4 pages	Annexed to letter dated 22 March 20-22 sent by Express Post to Executive General Manager Australian Competition and Consumer Commission	Email from ACC received 19 April 2022	1 page	ACCC had established an “investigation team” to “consider your complaint”.  We “have read your very helpful letter”.  ACCC wanted to have a formal phone call with me and Margaret.
Table I - HCF Claims History Details as at 10 March 2022 compared to Services Provided to Margaret by Lift	13 pages	Annexed to letter dated 22 March 20-22 sent by Express Post to Executive General Manager Australian Competition and Consumer Commission	Email from ACC received 19 April 2022	1 page	ACCC had established an “investigation team” to “consider your complaint”.  We “have read your very helpful letter”.  ACCC wanted to have a formal phone call with me and Margaret.
Table II: HCF Advice of Lift Cancer Care Services Claims Acceptance and Rejection	10 pages	Annexed to letter dated 22 March 20-22 sent by Express Post to Executive General Manager Australian Competition and Consumer Commission	Email from ACC received 19 April 2022		ACCC had established an “investigation team” to “consider your complaint”.  We “have read your very helpful letter”.  ACCC wanted to have a formal phone call with me and Margaret.

 

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My 22 March 2022 letter began by saying that I wanted to bring to the attention of the ACCC, conduct by HCF and other private health insurance funds which I believed involved repeated and serious breaches of the Commonwealth Consumer Protection Law through false and misleading conduct, and probable cartel behaviour.

I summarised Margaret’s cancer treatment and our possession for some years of private hospital insurance and how the refusal of HCF to pay for Margaret’s treatments at Lift Cancer Care Services meant that since 1 December 2020, we had been paying in full for her treatments and attempting in vain to obtain reimbursement from HCF under our health insurance.  I set out the dates of my various letters to HCF and the dates of the few responses from HCF.  I set out the dates of my various letters to the Ombudsman and the dates of the very limited responses from the Ombudsman.

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I said this about the Ombudsman.

The kindest thing I can say about the Ombudsman is that the officer tasked with handling my complaints is completely out of her depth.  If I were into conspiracy theories, I could probably put forward a number of seemingly plausible, alternative reasons for the considerably less than adequate action taken by the Ombudsman.

 I believe that what I said about the Ombudsman was excessively kind.  I believe the reality is that the Ombudsman was corrupt.

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I said that as at 22 March 2022, we had paid $8,623.00 for Margaret’s treatments, that HCF had formally rejected only one claim and that the stated reason for rejection in that case made no sense.

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Next, I dealt with what I called the legislative Puzzle Park and referred to a summary of the law which I included with the letter.  I said this about the legislative Puzzle Park.

I am satisfied that HCF, NIM and Teachers Health, are knowingly and intentionally [the bold print appeared in the original letter] breaking the law.  I also believe they are breaking the law knowing that the holders of health insurance who are affected by their unlawful actions will almost certainly die or lack the energy to call them to account for their unlawful behaviour.  Rather than clutter this letter with the full exposition of the relevant legislative provisions, I am attaching an explanation of the legislation as an Annexure to this letter… You can do your own detailed study of the law later to verify that I am correct in my interpretation of the relevant legislation.

 

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Next, I summarised what I had learned at the Patient Support Meeting on 6 March 2022.

·         One cancer patient had tried to lodge a claim with the Westfield Marion Branch of HCF and had been unable to do so – the computer system would not permit her claim to be physically lodged at the Branch. ·         Another patient said that she had looked online at her health insurance claims record and that it did not include any record of claims for treatments received by her at Lift Cancer Care Services.

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To my amazement, the staff in the ACCC both responded to my letter and they also seemed to be sympathetic to the appalling treatment that had been dished out to us by HCF and by the Ombudsman.

The ACCC was the ONLY government agency which showed any signs of caring about how to bring an end to the unlawful behaviour of the health insurers.