Australian Watchdog Fines Bupa A$35 Million Over Denied Health Claims

The ACCC, the nation’s consumer watchdog, initiated legal action against Bupa, accusing the UK-based company of employing “misleading and deceptive” practices between May 2018 and August 2023. Per a statement from the regulator, Bupa systematically denied entire claims if any part of a multi-procedure claim was found to be ineligible, despite other parts of the claim being valid.

This conduct specifically involved what the ACCC described as “mixed coverage” claims — instances where patients submitted claims covering multiple procedures during hospital visits and sought to verify their eligibility for coverage. The insurer’s practice of rejecting the full claim when any element was uncovered left many customers bearing unexpected out-of-pocket costs.

Gina Cass-Gottlieb, chair of the ACCC, noted in a statement that thousands of members were adversely impacted by Bupa’s approach, with some forced to pay additional expenses, upgrade their insurance policies, or even forgo or delay necessary treatment due to financial constraints.

“Bupa’s conduct affected thousands of members over more than five years, and caused harm to consumers some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies,” Cass-Gottlieb said per a statement.

Nick Stone, head of Bupa Asia Pacific, confirmed the company’s admission of “unconscionable conduct” and reported that it had already disbursed A$14.3 million in compensation covering 4,100 claims and eligibility checks. “This should never have happened,” Stone said.

While Bupa and the ACCC have agreed on the size of the fine, a court will formally determine the final penalty, which could be subject to change.

Source: AFR