Health insurance dies with you in technical loophole

Lynn Conder says she was stung by a $600 ambulance bill after her husband Dave's unexpected death. (ABC News: Wiriya Sati) Link copiedShareShare articleIt has been a decade since Lynn Conder lost her husband Dave unexpectedly. She was overseas visiting her brother when her husband stopped answering her calls home. A neighbour went to investigate and found the macadamia farmer had died in his sleep from a suspected heart attack after a night out for his birthday. As Ms Conder dealt with the complexities of her husband's funeral and estate, among the paperwork was a $600 bill for the ambulance that took his body to hospital for a post-mortem. When she tried to claim it on the couple's private health insurance, she learned from the ambulance service her claim was initially rejected. "It was just a real shock. I had the ambulance administrators calling me too because they were wanting their money," she said. Advocates say it is an example of the complexities of ambulance coverage nationally. The brutal reality was that it was perfectly legal for the insurer to reject the claim. Medico-legal expert Margaret Faux said it was because under health law a corpse was not considered a patient, and therefore no longer covered by their health insurance. "So this is a really sad situation, but private health insurers have absolutely no legal obligation whatsoever to cover the cost," Dr Faux said. It dates back to a 1989 court decision that ruled a GP could not claim death certificates on Medicare because a doctor could not treat a dead body. "It's a real gap and we really need to do better to help patients understand what it is they're buying when they buy health insurance." Consumers Health Forum of Australia chief executive Elizabeth Deveny said Ms Conder's experience was not unusual. Generally, when a patient is expected to die at home, their body is collected by a funeral home. In the case of unexpected deaths, police often call coroner's court contractors. But in regional and remote Australia, like the NSW mid-north coast where Ms Conder lived, often it falls to ambulance services if the deceased person needs to go to hospital for post-mortem. Ambulance services told the ABC the bill was often paid for out of a deceased person's estate. Dr Faux said the problem was indicative of "deep structural flaws" in private health and Medicare laws that she felt needed a major overhaul. "State variations don't help, it just amplifies confusion," she said. Health Minister Mark Butler's office declined to comment on the laws. Unexpected costs when someone dies are among the pitfalls in ambulance charging in Australia. The way public ambulance costs are treated varies widely between the states, with flow-on effects for both public patients and those with private health insurance. In some states, ambulances are covered by state governments, while others have multiple carve-outs including free ambulance services for groups ranging from pensioners to victims of violent crime. The ACT even offers free ambulance rides to Good Samaritans injured in an emergency. Some states also run their own roadside assistance-style membership schemes and only some have reciprocal arrangements if a resident needs an ambulance while visiting another state. Emergency ambulance services aren't always free if you're travelling interstate. Consequently, many people also have ambulance cover on their health insurance policy to cover potential costs. Dr Faux warned that sometimes people lived in a state where ambulances were free, but later forgot to add it to their private health cover if they moved interstate. She added that even within ambulance cover there was variability between private health insurers. "Some private health insurers will cover you to take you to a hospital. Others will not cover you if an ambulance is called out to see you, say, at your home, but they don't then transport you to hospital." Ms Conder said she and her husband had ambulance transport on their policy and it should have been covered. "That's why you take out insurance, hoping that if something terrible happens there'll be a process." Residents get a 49 per cent discount but visitors pay full price. Free for concession and veteran Gold and White card holders, along with those in state care or a victim of some types of assault. Free for some concession card holders, those in state care and certain asylum seekers. Ambulance Victoria runs its own voluntary insurance membership scheme. No cost for residents even if they call an ambulance interstate, but visitors to the state may be charged. Residents are charged. Some discounts for concession card holders. They also run a membership-style system. Free for residents but some upfront cash might be required for reimbursement through motor vehicle and workplace injury insurance schemes. It has reciprocal agreements with five states and territories, but not necessarily for aeromedical. Charges app

Health insurance dies with you in technical loophole

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