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Peoplecare Health Insurance

Peoplecare Health Insurance

3.7 from 64 reviews

Would not recommend Peoplecare to anyone based on my experiences

I knew I had to get major dental work done. Before I got the work done, I contacted Peoplecare to confirm I was covered / hadn't exceeded any relevant limits. I was told I was covered for a large portion up to a certain amount. I got the work done and submitted the claim at the end of April 2019. When we didn't hear anything back, I followed up in mid-late May 2019, and was told over the phone that the claim was denied on 2 May 2019 because a limit was exceeded. I still haven't received any written notification or reasons. We will be disputing any denial of a claim with the PHIO if not resolved with Peoplecare.

On a broader note, we also requested a Member Benefit Statement from Peoplecare back in April 2019. Going through it, we realised we were paying Peoplecare thousands of dollars in Provider Fees, and not even receiving half of that back through Total Benefits. We have decided to shop around, and have been pleasantly surprised by what's on offer out there. We are looking forward moving forward with a different fund, and putting Peoplecare behind us.

Value for Money
Transparency
Customer Service
Plan CoverageHospital and extras
Claim MadeYes
Claim DateApril 2019
Claim ApprovedNo
1 comment
Hi Dee, We’re so sorry to hear you’re unhappy with us and we’d love to look further into this for you. Would you be able to privately message us with your member number, phone number or email address and we’ll get to the bottom of it? Hopefully, this will then set your mind at rest and please do let us know if there’s anything else we can do to help. Take care, Monique @ Peoplecare

Very disappointed

I have been with peoplecare for 33 coming to 34 years. I now have my child and husband with peoplecare. My policy payments are directed debit so payment is always made. Recently, my child has required an item that costs $1500. However upon calling peoplecare and going through nearly a week process of providing documents we were rejected for more help. Only being able to claim $200. After research and speaking to other companies, they offer more in return and willing to waive my waiting periods. Loyal members do not get looked after. Doesn’t matter if you’re 3 years or 30. They will put you through a process to be rejected in the end. You pay for insurance to get close to nothing in return. Poor effort Peoplecare.

Insurance claim madeYes
4 comments
Hi EO1, we’re sorry to hear you’re not happy with us. I can see you’ve spoken to some of our customer service consultants who have explained that we don’t usually have a benefit for that type of item, but we wanted to try to help, so we arranged a special benefit of $200 for you as a goodwill gesture. I’m sorry this didn’t meet your expectations and we’re always happy to chat further. Please let me know if you’d like to discuss again with one of our experts and I’ll organise that for you today. If there’s anything else I can help you with in the meantime, please let me know. Take care, Brooke @ PeoplecareIt’s not a special benefit if health aids are already covered on my policy.......It’s funny you write special benefits when my policy already has health aids of $200. I can screenshot this and post it here for you?

Misleading

I have been a member with Peoplecare since 2011
I pay $341 a month I am a loyal member
I was diagnosed with kidney cancer and needed an urgent operation
I contacted Peoplecare directly and quoted them item numbers to confirm I was covered for these procedures.
I thought I would have peace of mind with Peoplecare that they will take care of my expenses, I had prepaid $5392 in surgical and hospital fees.
What did I get back from Peoplecare $322
I am very disapointed

Insurance claim madeYes
3 comments
Hi Paul, sorry to hear that you’ve been through such a rough time with your health and hope you’re doing OK. As mentioned in our other messages and over the phone last week, we do take care of 100% of the contracted hospital charges with your recent admission. Large out of pocket expenses like the ones you’ve described only happen when your specialist chooses to charge more than the Medicare or contract fee for a procedure. We help our members minimise their out of pocket expenses through our Access Gap scheme and Find a Provider tool, which helps you identify one of the 36,000 doctors who participate in our Access Gap scheme https://peoplecare.com.au/Members/Providers/Doctor. The best thing to do is contact us as soon as you know you’re going to hospital and we can guide you through the process. If you’re not happy with the large gap payment your doctor has charged in your case, the best thing to do is to contact them or the Royal Australian College of Surgeons. I’d be more than happy to have someone in Customer Service give you another call and explain any other questions you have if this would be helpful. Please let me know and I can arrange that for you today. Take care – Brooke @ PeoplecareI did contact people care two days before surgery I gave the person the 4 item number that will happen during surgery I asked am I covered and the lady confirmed with a yes and did not say any more about my extra out of pocket expenses. It was written in my pre surgery list to make sure I contact my private health find and that I was covered.Hi again, Paul! I've arranged for our hospital guru, Steph, to give you a call to explain the process your doctors should go through to give you Informed Financial Consent, so that their charges are clear and you know exactly what you'll get back from Peoplecare, what you get back from Medicare and how much they charge over the Medicare Scheduled Fee or our Access Gap Scheme (this is your out-of-pocket cost). We're more than happy for you to yell out if you have more questions! Take care, Anita @ Peoplecare

Great company

Been with CUA healthcare for 2 years now.
They've been excellent.
Great customer service.
Quick to get back to you and super fast at reimbursing when claiming.

Insurance claim madeYes
3 comments
Hi Marika! Are you a Peoplecare member or with CUA? It looks like you’ve reviewed the Peoplecare page by accident - oops. But thanks for the 5 star review! ;) Take care – Brooke @ PeoplecareI am a member, I wrote Cua as opposed to peoplecareOops - our bad, we were just making sure. Well we're glad you're with us, Marika! And thanks for the fabulous review, I'll be sure to pass on your lovely feedback to the team. :) Take care - Brooke @ Peoplecare

Good at taking payment and that's about it

Paid my premiums for years without claiming a single item, payment method failed and when I called to rectify and pay up to date they told me my cover had been cancelled and my cover level was discontinued anyway so I would have to sign up and re-start waiting periods. An excellent opportunity to look for an alternative provider.

Insurance claim madeNo
1 comment
Hi BartholemewH. Sorry to hear you’ve had some issues with your payments. We do understand it happens sometimes and so we always give our customers a fair chance to catch up with payments. We reach out to remind customers at least 3 times over 2 months before we stop a membership, and it sounds like this is what’s happened in your case. I’d be happy to look at your situation in more detail if you’d like to email me at helllo@Peoplecare.com.au. Take care, Monique @ Peoplecare

Raising premiums and less choices now

Even though customer service is generally good and friendly , really disappointed they have raised premiums again and now have cut further choices of hospital cover. They said the intermediate cover may come back with different benefits. The sad part is we have no say in anything about this regardless of your family or individual situation.

Insurance claim madeNo
1 comment
Hi Lesley, we’re sorry to hear you’re not 100% happy with us. The sad fact is that health costs are going up much quicker than inflation, which means our costs have to go up too. It’s also not just that costs are going up. The amount the Government pays towards private health cover membership has decreased, so you end up covering more of the cost yourself. In terms of our intermediate cover, we are working on a new one and will let our members know when it launches. It might be a little different to the old one, but will still sit between our basic and premium option. We do understand that money can be tight, and we’re happy to talk you through your options and see if we can save you $$. If you’d like one of our Customer Service experts to give you a buzz to have a chat about what’s best for you, private message us your details and a preferred time and I can arrange that for you today. Take care – Brooke @ Peoplecare

Always helpful

Have been with them for only 1 yr and within a few months needed 7 of my sons teeth removed in hospital. They were extremely helpful. Have always found very little waiting time on the phone and they even reissued my reward bonus when I failed to activate it. Thanks George for the great service. I love the way they don't force you to do everything online!! We have basic cover but still peace of mind, in fact the price I paid with my old fund when swapping I was able to include basic extras. Now that's a bonus I never expected!! Seems only the people who have problems seem to do reviews. I must admit getting this through took patience and persistence, I can see how you would give up unless you had a crappy experience, anger makes you more determined.

Insurance claim madeYes
1 comment
Thank you for the awesome review Maz! We just love hearing that our members are happy with us. We’re looking forward to keeping you and the family happy for many years to come. I’ll pass on your lovely feedback to George and the team, they’ll be chuffed. :) Take care – Brooke @ Peoplecare

I love Peoplecare

I have been with Peoplecare since 1967 when it was Lysaghts. I have always found them helpful, polite and ready to listen. In fact they have at times gone above and beyond to help me.

Insurance claim madeNo
1 comment
Aww you’re making us blush Ann! Thanks for the kind words, we love to know our members are happy with us. Here’s to many more years to come! Take care – Brooke @ Peoplecare

Be careful and read fine print for unexpected expenses

Ordinary. Questioned out of pocket expenses over and above excess and I was told how lucky I was that the fund pain $19k in medical costs. We have paid into the fund over 20 years. Please

Insurance claim madeYes
4 comments
Hi Chronic, thanks for getting in touch. It sounds like you’re talking about out-of-pocket expenses caused by your doctor either charging over the Medicare scheduled fee and/or not participating in our Access Gap scheme. We can help you with what to ask your doctor to try and reduce your out of pocket costs. And we have agreements with over 36,000 doctors around the country too. I’d like to look into this further for you, and make sure you have all the info you need. Please email hello@peoplecare.com.au your name and membership number and I’ll have one of our Customer Service experts get back to you. Take care – Brooke @ Peoplecare.I have actually gone through the process. The initial person I spoke to couldn’t help, then I was told by the second person that because of what Peoplecare paid during my hospital stay I should be grateful. When I do the math Peoplecare should be more than happy that my wife and I have contributed for over 25 years. We will be looking elsewhere now. Overall I felt very belittled after speaking with the Peoplecare representatives in particular the second individual I spoke to.I'm so disappointed to hear this, Chronic and I'd really like to look into this for you, because looking after our members during their healthcare experience and making sure they have all the info they need is super important to us. Could you please email me your details to anita.mulrooney@peoplecare.com.au and I'll review your case personally. Please give us a chance to make it up to you because it's not at all typical of the customer service we pride ourselves on. Take care, Anita Mulrooney, Head of Customer Service at Peoplecare.

Excellent Health Insurance Product and Service

I've been a member of Peoplecare (and BHP Industry Fund predecessors) since Jan 1997. The policy has always been competitively priced and the customer service, including refunds, etc, exceptional. Previously I was with Medibank. Chalk and cheese.

Insurance claim madeYes
1 comment
Wow Doug - 21 years! We hope you’re with us for many years to come. :) Thanks for the 5 star review and kind words. I’ll be sure to pass on your lovely feedback to the team. Take care – Brooke @ Peoplecare

Long Term customer - Poor service received Peoplecare are a joke

Staff are unhelpful and don't know how many people actually work for their organisation.

Get new staff they are crap and dont know how to deal with customers.

Spoke to a team member today to hold my membership whilst out of the country received verbal confirmation from the team member that I would not be charged today and the next fortnight. Surprise surprise I was charged sent an email to info@peoplecare.com.au @ 12.24pm no response then called the contact number and spoke to the most unhelpful person [name removed] who doesn't work for accounts yet tried to advise incorrect information.

I have been asked to send my bank statement to them so they can confirm payment what an inconvenience

Am currently looking for a new health insurer as this mob are useless pretty disappointed actually.

Insurance claim madeNo
3 comments
Hi Jacky, Sorry to hear you’re unhappy with us and I’ve looked into it for you. Firstly, I can reassure you there’s absolutely no issue with you getting a refund. I’ve had a chat to the Peoplecarers who you spoke to and they explained that there’s no issue with your overseas travel suspension. I understand you requested this the day before your travel, and what our Peoplecarer didn’t know at the time was that the direct debit had already been sent to your bank. There is always a gap between us sending the file to the bank and the bank taking the money out of your account. So, while your account was debited as usual, there’s absolutely no problem with getting a refund of this amount. As our Peoplecarer explained to you, we just need to make sure the direct debit came out of your account, but it takes the bank a couple of days to send through this info. So, if you’d like your refund sooner, we’re also happy to accept a copy of your bank statement or a screenshot of the direct debit, so we can get it back to you straight away. It's completely up to you which you’d prefer, but your refund will be issued in the next couple of working days regardless. Hopefully, this will set your mind at rest and please do let us know if there’s anything else we can do to help. Take care, Anita @ PeoplecareAnita, please don' offer a generic response it is wasting mine and your time. The fact your customer service people are incompetent and that the 3 emails I have sent to info@peoplecare.com.au are STILL UNANSWERED quite pathetic really. No one is accepting responsibility just excuses really. Save responding to this I am not interested in more garbage I will call you to cancel my membership once I am back and find a more organized company to deal with.Hi Jacky, just letting you know your refund has been organised today. If you need anything else, please don't hesitate to contact us. Have a lovely Christmas - Anita @ Peoplecare

long term member- totally disgusted

totally disgusted in how I was treated and how a claim was handled, exceptionally poor customer service not only from staff but from a supervisor, what a joke, looking for abother provider

Insurance claim madeYes
1 comment
Hi Michele, sorry for the late response we only just came across this one. I know it's been a couple of weeks, but we would love to look into this one for you. Please private message us your member details and we can look into this for you asap. Take care - Brooke @ Peoplecare

Poorcare, but they look great

I was with BUPA overseas after many years wth HCF in Sydney. I thought the look and feel of Peoplecare was attractive. Very approachable, good people with good intentions. That's all marketing. Fantastic marketing. When it comes to the nitty gritty of what you get - it's a complete rip off. Beware the waiting periods. Where are they disclosed? Up front like the friendly casual look and feel? Nope. And I've never ever experienced waiting periods like these guys - astonishing. I just wanted to claim cover for getting some glasses and a regular check up at the dentist. Nope.

Insurance claim madeNo
1 comment
Hi there, we’re really sorry you feel this way – that’s definitely not what we’re about. We communicate our waiting periods in our brochures, website and over the phone and will always be up front with these! We don’t want to hide anything from our members. If you’ve transferred to us from another fund where you had similar or higher cover and you’ve finished your waiting periods, you won’t have to serve those waiting periods. On the other hand, if your old cover had lower limits or benefits than your new one (or you haven’t had cover for a while), our optical is a 6 month wait, and general dental is a 2 month wait for Extras. Our waiting periods are in place to protect our Peoplecare members from ‘hit & run’ claims from new members. I would be happy to look into your situation for you if you think you’re experiencing longer waits for these services. Please private message us your name & member number and I’ll look into this ASAP. If there’s anything else I can help you with in the meantime, please let me know! Take care – Brooke @ Peoplecare.

Rude, condescending, deceiving, have to follow up with claims, or else they don't pay.

When I first signed up with Peoplecare 'Hospital and Extras' it cost me more than $2000/year, they were more than willing to answer my questions and return calls with my 'LHC' inquiries.
There were times for them to pay a claim, simply wasn't as straight forward as other insurers, which can be time consuming to have to prove to them payments were not received, and this back and forth stuff can get too much, they are not apologetic when they make mistakes, and if anything they are defensive!
A month ago I decided to change over from 'Hospital and Extras' to just the 'Extras' a big step down and I was going to save heaps, only costing me less than $600/year. One particular staff member became incredibly rude, and blurted out random negative feedback, which made me very uncomfortable. Then when I asked to speak with a manager, she was worse and came across quite aggressive in her mannerisms and extremely condescending. She made many excuses to not help with a serious inquiry, and would repeat, 'now moving forward', over and over.
Customer support records are not up to date, and communication skills are non existent in my opinion.
PEOPLECARE, I'm happy to find another insurer, an insurer who is more efficient, who pay claims without the customer having to follow up 10 calls later. Most of my reviews are about the importance of customer support, not being respectful of your customers is enough reason for me to drop you and find a safer reliable Health Insurer.

Insurance claim madeYes
7 comments
Hi Ja, this is definitely not how we like to look after our customers and I'd like to look into this for you urgently. Could you please private message us your name on here or send us an email to hello@peoplecare.com.au and I'll look into this for you straight away. Take care - Brooke @ PeoplecareHi Brooke, very disappointed after receiving an email from Peoplecare today, that I owe more money than the quoted original monthly cover. They changed it 3 times, first they said $40 per month, then I received an email that it was $46 per month, and today they want another $23. Seriously what's going on here?? From $40 to nearly $70 per month?? Plus the dates have been changed from when I downsized. I changed my cover on the 21 July and your staff delayed the change to the 26 July!!! Is this a case for the ombudsman?Hi Ja, I've sent you a private message asking for some more details as I would really like to look into this issue urgently. Please reply to the private message and I'll look into this straight away for you. Take care - Brooke @ Peoplecare

Pretty Good

I bought extra health cover from them before, they were pretty good with customer service and claim. Was happy with them. I didn't feel I needed the extra cover, so I cancelled it, and they helped me with the cancellation straightaway. If I were to get extra health cover, I think I'd choose them again.

Insurance claim madeYes
1 comment
Thanks for the great review, Hans! It’s nice to hear that your experience with us was so easy. If you ever want to join back up, please visit peoplecare.com.au or give us a buzz on 1800 808 700. Take care – Brooke @ Peoplecare

Good while it lasted - leaving today.

I've been with Peoplecare for about 5-6 years on their top hospital and extras. Paid many thousands over the years and claimed very little, but I felt secure knowing that if I did need a major claim I would be fine.

From the few claims I have made the process has mostly been painless and it is great to call and get a local person.

However, as with other health funds prices have gone up a lot since a couple of years ago, the latest increase quite steep. On top of that I have had my employment hours cut basically in half. I now rely largely on Government benefit to pay rent, food, etc... really hard currently, until my work picks up again in a few months. I called Peoplecare about a temporary suspension, BUT, I don't qualify unless I'm totally unemployed. Despite experiencing financial hardship under the pure definition I do not meet their definition/criteria. So I had to decide whether or not to forego my 2 shifts a week at work and become totally reliant on Centrelink in order to meet Peoplecare's criteria and therefore be granted a suspension, keeping all my served waiting periods etc... or be forced to totally cancel my membership and then in a few months join again (maybe not Peoplecare) and reserve all the waiting periods again?

I have decided to cancel because I think it would be foolish and unfair to taxpayers for me to deliberately forego work and rely on Centrelink.

Anyway, obviously Peoplecare have their reasons for such criteria, I suspect it might be to deter anyone trying to exploit them in some way, although I can't think how right now. Nonetheless, I now feel I have wasted thousands of dollars over many years and I certainly don't feel like Peoplecare actually do care.

Goodbye private health insurance... and having worked in Private Health Care myself I have personally witnessed so many things wrong with the whole private system that I often think a person is better off in the public system for most medical issues.

Cheers!

Insurance claim madeYes
1 comment
Hi Pookie, Thanks for choosing to be with Peoplecare for the last 5-6 years and it’s great to hear you have been happy with our service and claims. I’m really sorry to hear that you’re having a hard time financially. We know money’s tight for a lot of people and do everything we can to keep our prices competitive, but we also want to make sure that we don’t cut costs by taking away any of the benefits or services we offer. We do our best to look after all our members, which is why we do consider temporary suspensions for members who are unemployed (which most other health funds don’t allow at all). The tricky bit is making sure we have some guidelines in place to make sure we treat all members fairly and according to the same standards. And you are 100% right - at the same time we also need to make sure that we protect the interests of our other members by putting in place some simple guidelines to make sure that this doesn’t leave us open to exploitation by people who suspend their membership to avoid paying premiums and then reactivate when they need to claim. There are lots of different interpretations about what ‘financial hardship’ means, so we decided to use the Government standard, which is if the member’s receiving short-term income maintenance from Centrelink. We’re very sorry that this does not meet your own situation and we’d hate to see you leave us. We’d love to see if we can find other options that might be able to lower your premiums, so would love you to contact us with your details on hello@peoplecare.com.au and I’ll have one of our Peoplecarers give you a call. Take care and we hope things get better for you really soon. Anita @ Peoplecare

I can't complain...

We have been with them since 2012. During this time, we had 2 child births plus couple of other claims. All our claims were promptly settled. Compared to what we paid in 2012, we now pay $1000 more. I think it is the case with all health funds out there. I still think they are quite reasonable compared to the service we received.

Insurance claim madeYes
1 comment
Thanks so much for the review, Sanjeeva! I’ll be sure to pass on your lovely feedback to the team and I hope we can continue to make you happy for many years to come. Take care, Brooke @ Peoplecare

Don't feel valued!

Just had our premium increase by 6%! Been with Peoplecare for 5 years and obviously they feel we don't qualify for the average increase. We even have the top cover. Feeling a bit taken for granted by them to be honest.

Insurance claim madeNo
1 comment
Hi Ian, as a member owned, not-for-profit fund, Peoplecare puts the best interests of our members at the heart of everything we do. You’ve noticed your premium increase is slightly more than the average in our industry, so I’d like to give you some more info, which might help with your concerns. To be able to keep paying claims, we have to base our increase on what our members claim for – not the overall claims across the industry. We look at every level of cover individually and work out how much we need to increase the cost to keep people covered on that particular product. There are a few things we look at when we’re doing this review, including the claiming patterns of members on the cover. We know money’s tight for a lot of people and do everything we can to keep our prices competitive, but we also want to make sure that we don’t cut costs by taking away any of the benefits or services we offer. The other thing that comes into play is the adjustment to the Government Rebate that happens every year. The Government is now covering less of the cost of your health cover, and unfortunately that one’s out of our control. Thanks for choosing to be with Peoplecare for the last five years and we hope that you will stay with us for many more. Take care, Rosita @ Peoplecare

Getting expensive....

Just joined this fund a month ago to save some private fund cost and received a letter stating that my premiums will increase by 8.2% for the new year...this is $400 extra. The company is doing well with total equity up by 10.5% while cash flow is up 10.2% for the 2016 FY and so I am struggling to see the sense in the huge premium increase.

March 5th 2018 Update: Second consecutive huge premium increase OF 7.7%.

Last year I wrote about the 8.2% premium increase and got all sorts of explanations for that. This year my friendly premium increase letter states that there will be a 7.7% premium increase. Last year the 8.2% increase was way over the average industry increase while this year it is about double. So, over the last 2 years then we are experiencing a total increase of 16.5% I wonder what the explanation for this hefty increase would be this time! I will certainly start looking around for quotes from other providers this time as the rate of premium increases, so far above the industry standard, is just not fair and acceptable for a health fund who makes strong financial returns.

Insurance claim madeNo
13 comments
Hi Carel, Thanks for the comment and we agree that rising healthcare costs and health insurance premiums are an issue for all health funds in Australia. In short, we need to keep up with healthcare costs that are growing every year, as well as having more people claiming for these services. To give you an idea, in the last financial year we saw benefit payments go up by 14.8% for hospital treatments and 11.1% for extras treatments. All health funds need to apply to the Government to increase their premiums, and these are only approved if we can prove that they’re absolutely necessary and are the minimum needed to meet the ongoing payment of member benefits. The other thing that comes into play is the adjustment to the Government Rebate that happens every year. The Government is now covering less of the cost of your health cover, and unfortunately that one’s out of our control. As a not for profit fund we only charge what it costs to pay claims and run the fund. I can promise you that we’re always looking for ways to keep costs as low as possible while still giving you great quality cover and service. Not only that, but we also find ways to make money that we can put back into services for our members. At the moment we do that by managing two other health funds and by helping out Allianz Global Assistance (who provide cover for overseas visitors and students). Thank you for choosing Peoplecare and if you would like any more info, I’d be happy to help. Take care, Rosita @ PeoplecareHi Rosita, Thanks for the reply. I understand the increase in benefit payouts...but this will be partly due to the increase in new members making claims. Now, these new members are paying premiums each month and the extra cost of these claim numbers quoted will be offset by the increased revenue in premiums. As I stated in my message, the financial situation of the company improved by over 10% and I really cannot see why I have to get slugged with a 8.2% premium increase. I am sure this increase is well above the industry norm. The government rebate, in my case, reduced from 17.8 to 17.3% and this makes less than $3/month difference on my premiums and therefore cannot really be blamed for such an increase in premiums. I still think an 8.2% increase is unfair given the improved financial situation of the fund and that 4-5% would have been more realistic. By looking at the financial statement of the fund one gets the impression that increased revenue weighs more than the pain of increased premiums to members in the eyes of Management. It is these sort of outrageous premium increases that eventually forces people out of private cover and onto the public system....it is getting unaffordable at a rapid pace. Kind regards, CarelHi Carel, Thanks for your observations. Our average premium increase at 5.09% this year was very close to the health fund industry average and has been lower than the industry average over the past 5 years (the lowest of all open funds last year). The increases vary by product because we don’t cross subsidise between different products – this means that some products’ increases will be lower and some higher depending on the claiming patterns for each product. We strongly believe that this is the fairest way to treat all members. I’d be happy to look into your specific product in more detail if you’d like to message me your details to anita.mulrooney@peoplecare.com.au, You’re absolutely correct when you point out that the financial position of our company did improve this year (even though our underwriting margin was only 2.42%) and any surplus we make as a Not For Profit health fund is returned to our members through product & service improvements or other benefits. It’s important that our company continues to run at a modest surplus so that we’re around to support our members for many years to come. We’re really confident that Peoplecare covers are amongst the highest value products in the market and we’d be happy to help you compare if you need a hand – just let me know and I’ll arrange for one of our Cover Specialists to contact you. I hope this helps explains more about our premium reviews, and if you’d like to more info about our financials, please let me know and I’d be happy to contact you personally. Take care, Anita Mulrooney, Head of Customer Service @ Peoplecare

Admin hell

I had a claim repeatedly rejected. It was a simple case, I had symptoms caused by taking antibiotics, backed up by declarations from both my GP and specialist. I had no symptoms prior to taking the antibiotics.

Peoplecare categorised this as a pre-existing condition. I provided a large quantity of medical information, which wasn't deemed sufficient to prove I didn't already have the condition. I don't know what other information I could have given. The review process is opaque and the 'medical' expert reviewing the information does not appear to be objective, or impartial.

Insurance claim madeYes
3 comments
Hi MJay, I’m sorry to hear you’re not happy about our pre-existing condition process, which is one all health funds have in place as part of the 12 month waiting period for hospital cover for new members. This is in place to protect Peoplecare members from new joiners who claim for a condition they already had at the time of joining. All claims for new member in the first 12 months (apart from accidents) are sent to an external Independent Medical Officer, who reviews the information from your doctors to decide if there were signs or symptoms of the condition in the 6 months before joining. If there were, it is classed as a ‘pre-existing condition’ and a 12 month waiting period applies. We do it this way to leave the medical decisions to the experts, who are not Peoplecare staff and who are completely impartial. We’re also completely transparent about this process and pass the review information and reasons to you. I understand that you don’t agree with the decision and I believe we’ve already had reviewed it twice, by two different Independent Medical Officers. As our Peoplecarer mentioned to you earlier this week, we’ve offered to organise a 3rd review, and requested some additional documentation from your doctors, which we’re waiting on now if you choose to send it to us. We don’t have this pre-existing condition check to make things difficult – it’s just that as a Not For Profit health fund, we try to be as fair to our whole membership as possible, as it wouldn’t be right to pay a claim for a condition that a customer already had when they took out their new hospital cover. As I mentioned, do let us know if you’d like a 3rd independent review of your medical information and we’ll organise it as soon as you send the information we requested through. If there’s anything else we can help with, please feel free to get in touch. Take care. Anita @ PeoplecareThanks Anita. The issue here is administration. My case was flagged after my specialist entered a Peoplecare form incorrectly. Reviewing the form, the specialist had to enter 3 dates AND provide an estimate of time symptoms had been present for. This was entered incorrectly by the specialist. The form should simply ask for the date symptoms started. Additionally, Peoplecare required me to obtain all of their medical records, GP's notes and test results since January 2016. This has a substantial cost and takes a lot of time. My understanding is that this is very unusual practice and that the Health Insurer usually requests and gathers this information. In my case, the administration burden was enormous. I'm still extremely unwell and having to gather large amounts of technical information myself has been admin hell. I even had to make a GP appointment for them to release the requested information and this information still wasn't adequate. I appreciate the team at Peoplecare are very nice people, but you're falling over in basic administration with poorly designed forms and pushing extensive administration tasks on to your members, who could be extremely ill.Hi again MJay, Firstly, I’m really sorry to hear you’re still unwell and hope things are looking up for you soon. Thanks for the feedback about our form, which we’ll take into consideration to see if we can make it any simpler as we’re always trying to make things as easy as possible for our members. Also, all health funds have a similar process in place for claims in the first 12 months. The onus should be on your doctors’ surgeries to provide the information our Independent Medical Officer needs as it should all easily come off their system. It must have been frustrating for you if they asked you to make an appointment to ask for the information and if they’ve made errors. If it makes it easier for you, we would be happy to liaise with your doctors on your behalf, although they may ask you to provide your permission to release your records to us. Please do let me know if there’s anything we can do to facilitate the process for you. Take care. Anita @ Peoplecare

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Questions & Answers

I am considering changing to your fund - I have been fully insured with my current insurer for over 30 years. We ran into an unexpected problem when they refused to cover tests in Emergency before admission. What is the policy at PeopleCare
2 answers
no ideaThanks for getting in touch Steve. Sorry for the late response, we only just came across this one. Most funds don’t pay towards tests in emergency as the hospital considers you as an outpatient until you’re actually admitted as a patient. However, the hospital should be upfront with you about this and the fees involved. I hope this helps, please let us know if you have any more questions. If you’d like more info on our available covers PM us your details and I can have one of our Customer Service Experts contact you, or give us a buzz on 1800 808 700. Take care - Brooke @ Peoplecare

Hi what level of care is hip replacement covered...ty john.
2 answers
Hi John! Thanks for getting in touch. Hip replacements are covered under our Premium Hospital cover as a Private Patient in a Private Hospital. You would then also be covered for rehabilitation after your hospital stay. We’d be happy to chat to you further about this to make sure you have all the info you need before joining such as excess, out of pocket expenses and waiting periods. Please give us a buzz on 1800 808 700 or private message us your details and a time and date that would suit you best and one of our experts would be happy to give you a buzz. Take care – Brooke @ Peoplecare0419879381.

Hi, I would like to know which hospital cover covers endoscopy. Thanks
1 answer
Thanks for getting in touch, Alice! Endoscopy is covered in a private hospital on our Basic, Mid and Premium hospital covers. We’d be happy to chat to you further about this to make sure you have all the info you need such as excess, out of pocket expenses and waiting periods. Please give us a buzz on 1800 808 700 or private message us your details and a time and date that would suit you best and one of our experts would be happy to give you a buzz. Take care – Brooke @ Peoplecare

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Peoplecare Health Insurance
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