Northern Beaches members of national health insurer HCF will be forced to find another private hospital for treatment or face significant out-of-pocket expenses during a contract stoush where HCF accused Northern Beaches Hospital operator Healthscope of “putting profits before patients”.
The disagreement has resulted in HCF cancelling its contract with Healthscope hospitals, which includes Northern Beaches Hospital, meaning that anyone insured with HCF won’t be fully covered at any of Healthscope’s 38 private hospitals across Australia.
It will not affect public patients.
HCF members in the Northern Beaches received communication from the insurer stating that from 31 January it would no longer be covering patients who were treated at Healthscope hospitals.
The message stated that after this date HCF members could still be treated in Healthscope hospitals, but would face additional out-of-pocket expenses if they chose to do so.
A HCF spokesperson said they were continuing negotiations with Healthscope in the hope of coming to an agreement, however it accused the operator of focusing on its bottom line at the expense of patients.
“We’re hopeful we can keep negotiating with Healthscope so that by the time those dates roll around our members can have peace of mind they can access quality care at the hospital of their choice, and be covered,” the spokesperson said.
“If Healthscope still can’t negotiate with us in favour of our members, those members can still attend a Healthscope hospital, but may pay more out-of-pocket costs as determined by Healthscope.
“HCF is an Australian company and not-for-profit health fund which means our core focus is on the health and wellbeing of our members. We enter negotiations with our service providing partners with the mindset of members first.
“Unfortunately, Healthscope have put profits and recovery of lost margin due to Covid before patients and willingly acknowledge they will focus on servicing state public health waiting lists and self-insured over private health insurance members.”
“They’ve stated they are willing to go out of contract with all private health providers to pursue profits from state government hospitals trying to address long waiting lists.
“This would see the end of a partnership which has greatly improved the health outcomes of millions of Australians for over 20 years,” the spokesperson said.
The HCF spokesperson said Healthscope’s demands would force the insurer to pass the increased costs onto members, and with the cost of living rising at an exponential rate this was “not an option”.
“HCF will remain open to consider any alterative Healthscope considers will contain premiums and impact of consumers facing significant out of pockets.”
The spokesperson added if hospital treatments are booked before the end of January, members will be covered until end of July, with the exception of some treatments like pregnancy. Emergency admissions would also be covered until April.
A Healthscope spokesperson hit back at HCF, claiming that the insurer of not funding “the real and rising costs of our private hospital services”.
“This is a disappointing outcome, and certainly not our preferred option. However, HCF’s final offer was simply not enough to cover the cost of providing private hospital care for their members,” the Healthscope spokesperson said.
“The cost of providing quality hospital care continues to rise quickly, and is a challenge impacting both public and private hospitals, especially in the wake of the COVID pandemic.
“We have been challenged by health insurers not adequately funding the real and rising costs of our private hospital services, including rising interest rates, food, energy and power, insurance, nurse wages, PPE, maintenance and cleaning costs.
“These cost pressures have been well documented throughout the pandemic, and are now being exacerbated by the highest levels of inflation seen in decades.
“We will continue to negotiate with HCF in the hope of reaching an acceptable agreement.”
After the communication was sent out to members Manly Observer received a number of emails from concerned locals who would no longer have coverage at the only hospital in the region.
One HCF member, who had been with the insurer for over 20 years, contacted the Manly Observer stating that they were now considering switching health funds rather than travel to another hospital for treatment.
Any HCF members affected by this decision is urged to contact the health fund to discuss their options. The insurer suggested member consider going elsewhere, and would be happy to “assist with finding alternative hospitals participating in HCF’s hospital network to help you access reduced gap or no-gap hospital and medical services when the time is right for you.”