Finding a provider for a certain procedure When selecting a provider for a certain procedure, participants varied in their responses. Some used their doctor’s referral or recommendation, others made their own choice or asked friends / family / colleagues, and some consulted the insurer’s list of preferred providers. The majority of participants were aware of the existence of preferred provider lists, but only few had used them, usually motivated by cost. These participants gave mixed reviews as to the outcomes. “If you don’t use a preferred provider you don’t get as much back.” – Female, 53 years, private health insurance less than 12 months “I don't feel pressure but I get more money back so it's a preference for me… What's the point of having insurance if I'm going to use providers that I'm not covered for?” – Female, 34 years, private health insurance for 8 years In general, most participants felt empowered to make their own choices of providers. “No-one wants to be told they have to go to a certain doctor or dentist. You build an intimate relationship with these people.” – Female, 48 years, private health insurance for 5 years “I don't think we should be match-maker between insurance companies and health care providers. This is just not right.” – Male, 49 years, private health insurance for 5-9 years “Their preferred provider might not be my preferred provider.” – Female, 35 years, private health insurance for 5-9 years “When it comes to my health it's important for me to go to the doctor I have most confidence in.” – Male, 26 years, private health insurance for 5-9 years Experiences of expectations not met and challenges encountered Participants spoke about their expectations not being met due to inconsistent information, which largely resulted in them incurring unexpected costs for services and procedures due to not being covered and believing they were, and not receiving the rebate they were expecting. Unexpected costs experienced by participants included: Costs for anaesthetists and additional specialists / assistant surgeons; Emergency hospital admission fee; Private hospital excess; Co-payment; Tests;
B Policy benefits and exclusions – general (i.e. What services / procedures are covered) 02 02 C Gap and gap cover amounts 03 03 D What dollar value will be paid back per visit i.e. to the dentist, massage, chiro etc. 04 04 E Claims process 05 05 F Standard Information Statements 06 06 G Terms and conditions 07 07 H Waiting periods 08 08 I Dependants information 09 09 J Medicare levy surcharge / Government rebate 10 10 K Annual rebate limits 11 11 L Confidentiality and privacy agreements 12 12 M Information regarding pre-existing conditions 13 13 N Preferred providers / doctors / hospitals 14 14 O Accident and emergency 15 15 P Overseas private health cover 16 16 Q Policy upgrade information 17 17 R Underwriter of the policy 18 18 S Lifetime health cover 19 19 T Unsure / Don’t know 97 97 U Other, please specify: 96 96 Accessing benefits and making a claim Which of the following best describes you? SR I frequently access my private health insurance (i.e. I regularly make claims) 01 CONTINUE I sometimes access my private health insurance 02 CONTINUE