Demand Private Health Insurers for members choice providers
- by: Ashan Dissanayake
- recipient: Private Health Insurance Members
Private Health Insurance members are being denied access to unique superior service experience as a result of bullish attitude towards the independent hospitals. PHI members and the government of Australia invest a large proportion of funds on the HF’s with the expectation of access to quality, affordable & readily available health care of choice. Instead HF's have preferential agreements with the corporates denying the members access to providers of choice.
Dear Sir/Madam,
SleepMed Health Care is one of Western Australia’s premier sleep and respiratory consulting, diagnostic and treatment facilities. SleepMed Health Care is a registered hospital under the hospitals and health services act. Our team of outstanding medical professionals use accurate sleep diagnostic services, along with CPAP therapy management treating a wide range of sleep disorders. SleepMed Health Care is committed to delivering patient centric health care services of the highest quality.
Earlier during the year an application by SleepMed Health Care for a contract was declined by all the private health insurers. This decision highly inconvenienced PHI members seeking quality, affordable private health care at SleepMed Health. SleepMed Health Care offers a unique service facility, being the only fully accredited licensed standalone facility in WA specific for sleep disorders. As a result of the funds rejection for a contract, PHI members are being denied access to a unique superior service experience that is not available elsewhere in WA and has led to irate members. Health fund members and the government of Australia invest a large proportion of funds on the HF’s with the expectation of access to quality, affordable & readily available health care of choice.
SleepMed Health Care has fulfilled our statutory obligations in meeting with the compliance requirements under the Medicare regulations concerning item numbers, licences, accreditation and certificates. We therefore believe the declining of this application was unethical and in breach of the trust that the members and government of Australia have placed with the private health insurers.
However as part of our persistence we have been granted 2nd tier approval effective from the 20th of September as per Australian Private Hospital Association (APHA).
As per legislation Schedule 5 of the Private Health Insurance (Benefit Requirement) Rules (the Rules) made under item 3A of the table in section 333-20 of the Private Health Insurance Act 2007 (the Act), requires private health insurers (health insurers) to pay at least the minimum level of benefit set by Schedule 5 (“second tier default benefits”) provided in private hospitals. Under Schedule 5, the minimum level of benefit payable by a health in a facility which it does not have a negotiated agreement, is not less than 85% of the average charge for the equivalent episode of hospital treatment under that health insurer’s negotiated agreements in force on 1 August of the first year with comparable facilities in the State.
We are requesting private health insurers to be available to negotiate a favourable Tier 2 contract with SleepMed Health Care to service PHI members with the quality, affordable experience they deserve.
We appreciate your prompt attention to this matter.
Yours sincerely,
Ashan Dissanayake- GM (SleepMed Health Care)
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