Health funds accused of misinforming consumers

The information referred to by OA mainly concerns the marketing practices of major health funds, particularly in relation to preferred provider arrangents, and it has called on the Australian Competition and Consumer Commission (ACCC) to do more to combat what it says are anticompetitive tactics.{{quote-A:R-W:450-I:2-Q:The role of health funds should not be to ‘direct’ access to health care in any manner, rather provide clear and accurate information to allow the policyholder to make an informed decision about their health care.-WHO:OA submission}}According to the submission, the peak industry body believes there is a lack of consistent and transparent information provided to consumers by health funds regarding their optical entitlents, which could be compromising their ability to make informed healthcare choices.“We are aware of instances where health funds have encouraged policy holders to attend preferred provider optometry practices on the basis that they will ‘only’ receive benefits for optical appliances and/or specific eye health services if they attend such preferred providers… This is considered misleading as in actual fact most optometrists provide a broad range of clinical services,” the submission states.Another area of concern highlighted by OA was allegedly inconsistent or inaccurate information provided by health funds concerning the rebates their policyholders were eligible to claim. The Senate submission stated that as a result of this misinformation, consumers are frequently under the false impression that preferred provider sches provide no-gap or known-gap optical products, which is often not the case.“These situations can increase the risk of unexpected costs and ‘bill shock’ for the consumer, and also place unnecessary pressure on optometrists to cover the ‘gap’ in order to maintain the consumer’s immediate business,” the OA submission states.Anecdotal evidence received from OA mbers and presented to the inquiry also refers to health funds explicitly directing patients to avoid certain optometrists – including ones they have an existing relationship with – on the basis of th not having a preferred provider arrangent in place.“Another common complaint we receive is health funds directing patients to their preferred providers stating that patients will ‘save money’ – without any knowledge of what is being prescribed, how products compare or what is clinically appropriate for the patient,” the Senate submission reads.“The role of health funds should not be to ‘direct’ access to health care in any manner, rather provide clear and accurate information to allow the policyholder to make an informed decision about their health care.”Other criticisms levelled by OA at major health funds include the potentially negative impact their preferred provider sches can have on rural Australians and smaller optometry clinics, as well as possible conflicts of interest arising from health funds that also offer services covered by their insurance policies.OA has recommended greater transparency in terms of the information provided to consumers and more active monitoring of anti-competitive behaviour by the ACCC as two possible solutions to the issue.However, such an outcome appears unlikely, given an ACCC report on alleged anticompetitive practices by health insurers submitted to the Senate earlier this year stated: “The ACCC recognises the concerns raised by industry associations about the potential impact of preferred provider arrangents and has previously considered similar issues. The ACCC’s current assessment is that these matters are unlikely to raise competition issues under the CCA [Competition and Consumer Act 2010].”A report on the inquiry from the Senate committee is expected in Novber.More information:–  Optometry Australia’s submission.