Helping Consumers to Navigate Change Presentation to 13 th Annual Health Insurance Summit 28 th July 2014 Samantha Gavel, Private Health Insurance Ombudsman
Jun 20, 2015
Helping Consumers to Navigate
Change
Presentation to 13th Annual Health Insurance Summit
28th July 2014
Samantha Gavel, Private Health Insurance Ombudsman
Private Health Insurance in Australia
Over 10 million privately insured members;
34 private health insurers (12 are restricted
access insurers);
5 largest insurers account for 82.3% of policies
nationally;
552 private hospitals; 762 public hospitals;
17,675 health insurance policies available for
sale (25,709 policies in total);
$13.16 billion in benefits in 2010/11.
Standard Information Statement
Complaints and Disputes
0
500
1000
1500
2000
2500
3000
3500
4000
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
All Complaints vs Disputes
All complaints
Disputes
Complaint Issues
0
200
400
600
800
1000
1200
Complaint Issues, 2011-12 to 2013-14
2011-12
2012-13
2013-14
Value of Complaints
Most dissatisfied customers don’t complain;
Satisfied complainants become greater advocates than those who’ve never complained;
Costs of complaints include loss
of loyalty, negative opinions and damage to reputation;
Value of good complaints handling not just to customers, but also to staff.
Good Complaints Handling
An organisational culture that values feedback and
complaints;
A complaints handling system that is accessible and
responsive to customers;
Proper resourcing, recruitment and staff training;
Good complaint handling processes that facilitate timely
investigation and resolution of complaints;
Analysis to identify and address systemic issues;
Regular review of the effectiveness and efficiency of the
complaints handling process.
Unreasonable Complainant
Conduct Any behaviour by a current or former
complainant which, because of its
nature or frequency, raises substantial
health, safety, resource or equity
issues for the parties to a complaint.
UCC can happen anywhere. It is not
limited to telephone communications
or face-to-face interactions with
complainants.
It can occur over the internet or on
social networking websites, in a public
location or in written correspondence.
Inappropriate and Unreasonable
Online Conduct
1. Monitor;
2. Evaluate;
3. Act;
4. Follow up and follow through;
5. Support affected staff members.