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Complaints about private health insurance

The Private Health Insurance Ombudsman (PHIO) can deal with complaints and enquiries about health insurance. The PHIO is a division of the Commonwealth Ombudsman's office. Before contacting the PHIO, a person wishing to make a complaint in relation to private health insurance should contact the relevant health fund to let them know about the problem and give them an opportunity to resolve it.

What complaints can be dealt with by the PHIO?

Complaints may be about a private health fund, a broker, a hospital, a medical practitioner, a dentist or other health care practitioner as long as the complaint relates to private health insurance.

What complaints cannot be dealt with by the PHIO?

Complaints regarding the quality of service or treatment provided by a health professional or hospital should be directed to the Health and Community Services Complaints Commissioner (SA).

The PHIO also does not deal with complaints regarding Medicare. Medicare complaints should be directed to the Department of Human Services Complaints and Feedback telephone number on 1800 132 468.

How to complain

Step 1: contact the health fund concerned directly and advise them of the omplaint.

Step 2: if no resolution can be achieved through the health fund concerned, contact the PHIO with details of the complaint.

The PHIO provides a complaints hotline on 1300 362 072 and an online complaints form is available on the Commonwealth Ombudsman - Private Health Insurance website.

When lodging a complaint, include details of:

  • the complaint
  • the name of the health fund concerned
  • the complainant's name and membership number as well as their contact information
  • what the complainant thinks would resolve the matter
  • any other information that will help explain the complaint
    Complaints about private health insurance  :  Last Revised: Tue Apr 16th 2019
    The content of the Law Handbook is made available as a public service for information purposes only and should not be relied upon as a substitute for legal advice. See Disclaimer for details. For free and confidential legal advice in South Australia call 1300 366 424.