Senator Griff tried to help and got nowhere.
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Margaret and I in Connemara, Ireland in August 2017
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Connemara, Western Ieland in August 2017.
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My Request to Senator Griff
My formal complaints to ASIC and ACCC were preceded by less formal approaches to get the law enforced.
I emailed a letter to Senator Griff at 5.31 pm on Monday 7 February 2022 saying this.
I am now aware that other cancer patients who have had difficulty in obtaining any payments from their health insurers have made formal complaints to the Honourable Steve Georganas MHR and the Honourable Nicolle Flint MHR. Your efforts to assist Margaret and myself may be enhanced by co-operation with Mr Georganas and Ms Flint. In addition to HCF, it seems that Teachers’ Health Insurance Fund has also refused to pay claims for services provide by Lift Cancer Care Services. It appears that Teachers’ Health fund has been almost as difficult to deal with as HCF – and just as evasive as HCF in relation to providing reasons for their refusal to honour claims for services provide by Lift. … Anything that you, Ms Flint and/ or Mr Georganas is able to do to assist Margaret and the other cancer patients who are affected by this horrible little saga will be very much appreciated. |
In my letter to Senator Griff, I included copies of my letters dated 7 February 2022 to HCF and the Ombudsman.
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Senator Griff rang me on Tuesday 8 February) saying he had received an email from the Minister for Health which he forwarded to me. I got the email at 7:22 pm on 8 February.
In fact, the Minister already knew all there was to know about the health insurance scam and had decided to ignore it. Under the legislation, the Minister was the ONLY person who could directly enforce the law – and Minister Greg Hunt refused to do this.
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Health Minister’s Reply
This is an exact copy of the answer given on behalf of Health Minister Greg Hunt to Senator Griff. The Minister’s response is a perfect example of Bulls**t Baffles Brains. The Minister never gave any further response.
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.
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:
sufficient information to identify the patient, the certifying medical practitioner and the specific medical procedure being certified 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 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.”
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Don’t try understanding the Minister’s email. It is unintelligible.
Health Minister Greg Hunt already knew ALL relevant facts about the health insurers – and he would not enforce the law. He was not seeking re-election and didn’t care. Sir Humphrey Appleby from “Yes Minister” would have approved the opening words of the email.
Please see advice below, which may also assist with engaging further directly with HCF. |
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The Minister was declaring in Bulls**t Baffles Brains language that he was never going to help in any way.
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