News eDaily12 Jun 2017

Australia:Insurers and public hospitals at odds over billings

12 Jun 2017

Public hospitals have been arguing with health insurance funds over what constitutes a general ward, as the states continue to subsidise their operations by billing insurers more than A$1 billion (US$753 million) a year.

The insurance industry maintains that Australians have a right to be treated without charge in the public system and should only bill their insurer if they have choice of doctor and other benefits, reported the newspaper The Australian.

But Queensland Health insisted the patients in question were admitted by designated specialist emergency physicians and said “most short-stay units are located within the Emergency Department (ED) but are physically and functionally separate and outside the usual scope of the ED activities”.

Queensland Health director-general Michael Walsh wrote to seven small insurers that last year refused to reimburse Queensland public hospitals for the cost of treating members in the state’s short-stay units. Mr Walsh suggested that their refusal to pay was “based on a misconception that short-stay units are part of the emergency department”. “The units have specific admission and discharge criteria and procedures similar to general wards,” Mr Walsh argued.

Federal Health Minister Greg Hunt has also called on the states to curtail their private billing, out of concern it will drive up insurance premiums and the cost of the federal rebate. The states argue, however, that the billing is legal and necessary.


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