Bupa Australia has agreed to repay millions of dollars to thousands of members after it was found to have wrongly rejected hospital claims, reported ABC News Australia.
The insurer admitted to misleading or deceptive conduct and making false or inaccurate representations by informing members they were not eligible for private health insurance benefits when, in fact, they were.
According to the Australian Competition and Consumer Commission (ACCC), some affected customers paid for their medical treatments out of pocket, resulting in significant financial burdens. Others felt compelled to upgrade to more expensive policies to ensure coverage.
In some cases, consumers experienced medical complications, physical pain, or emotional distress after either delaying treatment or undergoing repeated procedures due to being incorrectly told their treatments were not covered.
Bupa has reached an agreement with the ACCC on a proposed $35m penalty for incorrectly assessing thousands of mixed coverage claims over a five-year period.
Bupa has begun compensating affected members, medical providers, and hospitals, having already paid $14.3m across more than 4,100 impacted claims.