Bupa, one of Australia’s largest private health insurers, has repaid millions of dollars to thousands of policyholders after it wrongly denied hospital claims.
The company admitted to misleading and deceptive conduct, including falsely informing members that they were not entitled to certain benefits when they were. According to the ACCC, this led some customers to cover their own medical expenses—costing them thousands—or upgrade to pricier policies in order to secure coverage they should have already had.
Some patients faced serious consequences, including delayed or repeated treatments, pain, and distress due to the misinformation.
Bupa Faces $35 Million Penalty
Bupa has agreed to a proposed $35 million penalty with the ACCC over its handling of thousands of “mixed-coverage” claims between 2018 and 2023. In some cases, entire claims were denied when partial coverage should have applied.
Issues arose from Bupa incorrectly rejecting pre-procedure eligibility checks or automatically denying claims after procedures were completed, when a manual review was necessary.
Bupa also admitted to unconscionable conduct in the assessment of 388 specific claims that required proper manual handling but were instead processed incorrectly.
In a public statement, Bupa APAC CEO Nick Stone acknowledged the company’s failures:
“This should never have happened. We are deeply sorry for failing to get things right for our customers.”
He added that Bupa’s focus is now on compensating affected customers, healthcare providers, and hospitals, and ensuring such issues do not recur. So far, Bupa has paid $14.3 million related to over 4,100 claims.
ACCC and Government Response
ACCC chair Gina Cass-Gottlieb confirmed Bupa’s actions harmed consumers, some of whom postponed, canceled, or skipped treatment despite being partially covered. The consumer watchdog has accepted Bupa’s commitment to continue compensating affected individuals.
The company blamed the errors on unclear internal instructions, inadequate staff training, and delays in resolving problems.
Health Minister Mark Butler supported the ACCC’s action and criticized Bupa’s conduct, stating on social media:
“Australians pay their hard-earned money to private health insurance providers and they deserve better.”
He described the $35 million penalty as appropriate for a company that “deliberately misled and ripped off their customers.”
What Affected Customers Should Do
Anyone who believes they may have had a claim or eligibility check unfairly rejected can visit:
👉 www.bupa.com.au/mixedcoverage
or call Bupa on 134 135.
Private Healthcare Australia, the industry’s peak body, said Bupa must do everything possible to resolve the issue.
