Where private health cover lets people down, how to complain, and the official places to check the facts.
Most bad experiences with private health insurance come from a small set of misunderstandings: a Basic or restricted policy that does not cover the treatment someone needed, a waiting period that had not finished, an ambulance bill that Medicare does not pay, or a specialist's gap fee that nobody explained in advance. These guides describe those patterns so you can check your own policy before you need it.
Begin with the common private health insurance mistakes. Other guides cover restricted cover and exclusions, ambulance arrangements in each state and territory, being a public or private patient in hospital, the special Lifetime Health Cover rules for new migrants and Australians returning from overseas, how to read a Private Health Information Statement, and how to take a complaint to the Private Health Insurance Ombudsman at the Commonwealth Ombudsman.
This site explains how cover and costs work. It does not give medical advice. If you have symptoms or a health concern, talk to your GP, call healthdirect on 1800 022 222, or call 000 in an emergency.
Mistakes, Disputes and Official Sources
Medicare does not pay for ambulances. How ambulance costs work in each state and territory, who is exempt, and when to get cover through an insurer or state subscription.
Mistakes, Disputes and Official Sources
The steps for disputing a refused claim, a pre-existing condition decision or a billing problem, from the insurer's own process to the Private Health Insurance Ombudsman.
Mistakes, Disputes and Official Sources
Lifetime Health Cover base days for new migrants and returning expats, the one-year window, time overseas and suspended cover, Medicare eligibility and the surcharge.
Mistakes, Disputes and Official Sources
A section-by-section guide to the standard policy statement, and which government site to use for tiers, the surcharge, the rebate, Medicare, MBS fees and complaints.
Mistakes, Disputes and Official Sources
The common errors that lead to surprise bills or tax debts: restricted cover, waiting periods, gap fees, ambulance, the surcharge excess limit, the wrong rebate tier and lapses.
Mistakes, Disputes and Official Sources
Choosing between public and private patient status in Australian hospitals: costs, choice of doctor, elective waiting lists, emergencies and using private cover in a public hospital.
Mistakes, Disputes and Official Sources
The difference between covered, restricted and excluded clinical categories, what a restricted benefit pays in a private hospital, and how to check your policy.
