The operator of 38 private hospitals in Australia remains at an impasse with two major private health insurers in a dispute that could see millions of people facing out-of-pocket costs.
Healthscope announced in November that it would be cancelling its contracts with Bupa from February 20, and Australian Health Services Alliance (AHSA) from March 4.
It comes after the insurers refused to pay a proposed hospital fee of $50 for same-day patients and $100 for overnight admissions.
Healthscope argued the fee was due to rising costs, but the insurers claimed Healthscope — owned by Canadian private equity group Brookfield — was extracting more profits for its members.
Bupa contacted its customers on Thursday to raise the prospects of out-of-pocket expenses at Healthscope hospitals for certain services.
As an insurer, it is required to contact customers before detrimental changes to their coverage.
In an email to customers, Bupa recommended they request informed financial consent from the hospital prior to admission.
A Bupa spokesperson said negotiations with Healthscope are ongoing.
“Importantly, currently nothing has changed for our customers,” the Bupa spokesperson said.
A Healthscope spokesperson said the situation was not its “preferred option”.
“We continue to be in active discussions with Bupa to resolve the current funding issues, and to reach a fair and sustainable agreement for our hospitals and Bupa patients,” they said.
Who might be affected from February 20?
Without a contract in place with Healthscope, Bupa customers at these hospitals would revert to the second-tier default benefit.
NSW
- Campbelltown Private Hospital
- Hunter Valley Private Hospital
- Lady Davidson Private Hospital
- Nepean Private Hospital
- Newcastle Private Hospital
- Northern Beaches Hospital
- Norwest Private Hospital
- Prince of Wales Private Hospital
- Sydney Southwest Private Hospital
- The Hills Private Hospital
- The Sydney Clinic
- Tweed Day Surgery
- Windsor Road Private Clinic
Vic
- Dorset Rehabilitation Centre
- Holmesglen Private Hospital
- John Fawkner Private Hospital
- La Trobe Private Hospital
- Knox Private Hospital
- Melbourne Private Hospital
- North Eastern Rehabilitation Centre
- Northpark Private Hospital
- Rehab at Home
- Ringwood Private Hospital
- The Geelong Clinic
- The Melbourne Clinic
- The Victoria Clinic
- The Victorian Rehabilitation Centre
Qld
- Brisbane Private Hospital
- Gold Coast Private Hospital
- Peninsula Private Hospital
- Pine Rivers Private Hospital
- Sunnybank Private Hospital
WA
- Mount Hospital
SA
- Ashford Hospital
- Flinders Private Hospital
- Griffith Rehabilitation Hospital
- The Memorial Hospital
Tas
- Hobart Private Hospital
ACT
- National Capital Private Hospital
NT
- Darwin Private Hospital
This means the insurer would pay at least 85 per cent of the average cost of the same treatment at a similar private hospital that it has an agreement with, and the customer would pay the gap.
But there is a transition period before it comes into full effect.
From February 20 this year, emergency admissions would still be covered until May 20, pre-booked appointments are covered until August 20, and pre-booked pregnancy appointments are covered irrespective of delivery date.
A course of treatment bookings — such as chemotherapy and renal dialysis — are covered until August 20.
Should a member’s bookings not fall into these categories, Bupa encouraged them to contact their treating doctor to check if they operate at non-Healthscope hospitals within its network.
Healthscope operates 38 hospitals across Australia, including 14 in Victoria and 13 in New South Wales.
It operates some of the major private hospitals in smaller capital cities like Darwin and Hobart.
AHSA deadline also approaching
While the contract would end with Bupa first, other major health insurers could soon follow.
AHSA’s contract with Healthscope could end on March 4, affecting customers of 28 insurers.
These include AIA, GMHBA, HBF and Health Partners, and a range of not-for-profit and member-owned funds.
These customers would also move into the second tier default benefit, as well as a transition period.
AHSA is also continuing to negotiate with Healthscope.
It has contracts with 500 other private hospitals.
