PATIENTS are being hit with large, unexpected bills because of private health insurance policies that exclude coverage for common medical treatments, the head of the organisation that represents private hospitals has warned.
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Australian Private Hospitals Association chief executive Michael Roff is concerned that a large increase in the number of private health fund members covered by ''exclusionary'' products could undermine the value of insurance.
The proportion of health fund members covered by exclusionary policies rose from 12 per cent to 20 per cent in the June quarter last year, he said.
The policies varied, but typically did not cover common treatments such as knee and cardiac surgery and obstetrics care.
Mr Roff said many health fund members were unaware of the limits of their insurance coverage and in a small number of cases this had led to people being charged tens of thousands of dollars for medical treatment.
''People are brought in suffering a heart attack or something like that on the weekend and they've come through a private hospital emergency department and they can't actually check their policy until the Monday morning. And by that stage they might have had $30,000 worth of treatment,'' he said.
Mr Roff said some funds used their websites to position products that excluded treatments such as hip and knee replacements, cardiac surgery, lens procedures and dialysis as the ''normal'' choice.
''Our fear … is that in the long term it's going to undermine the value proposition of private health because people will go to use their health insurance and discover that they're not covered,'' he said.
Mr Roff said consideration should be given to requiring health funds to contact members at key stages in their lives and ask them to consider their future health needs.
NIB chief executive Mark Fitzgibbon defended exclusionary policies, arguing that they were driven by consumer choice and were up to two-thirds cheaper than other health insurance products. ''These are people who would otherwise be lost to the private system,'' he said.
Mr Fitzgibbon said funds encouraged members to consider upgrading to more comprehensive levels of insurance as they grew older. ''We're very active in communicating with people on lower-value products.''
Consumers Health Forum of Australia chief executive Carol Bennett said one insurance policy marketed to young people only included private hospital coverage for some accidents, removal of teeth, minor joint investigations, tonsillectomy and minor hernia surgery.
Australian Health Insurance Association chief executive Michael Armitage said financial pressures were forcing many to get cheaper policies.
