Frequently asked questions
Patient: What do I do when my health insurance claim is declined?
When your health insurance claim is declined, consider following these simple suggestions:
- Contact the health fund and discss the matter
- Have the matter escalated if there is no satisfaction
- Enlist the assistance of your practitioner
- Contact the PHIO
- If you have exhausted all these avenues without luck, contact me and I'd be happy to discuss possibilities.
My Case: Why didn't you ignore (HF) and work with other funds?
1. I have a belief to address your issues and don't let them manifest. I often deal with challenges until it is completed or resolved. That is why I continue to this day to uphold (HF) to honesty and fairness.
2. (HF) were the first insurance company that started Group Physiotherapy claims, they were the leaders. On this basis I wanted to partner with the leaders in the industry.
3. I was very overwhelmed at the time, due to the extreme stress I was sbjuected to and may not have made the best decisions. In hindsight, I would not change much in the way I processed the sitaution and conducted my approach.
4. I beleive it is important to stand up to bullies.
5. I wanted to know with a certain degre of confidence what Group Physiotherapy was and why my business was targeted when I doing the right thing, whilst at the same time (HF) were switching codes.
6. In the end I was scared out of business, because another health fund could do the same thing. I felt I had little rights. I was petrified. The whole occorance was gastly.
My Case: What was the impact it has had on you?
The depth of the effect has been significant. Loosing everything you worked for is tough to live with. I don't have much left.
The impact included, but not limited to personal affects, health, relationship affects, motivation, loss of innocence, business related, financial, reputation affects.
At the time of writing, I have not worked as a clinician for over 12 months.
The way I have been treated does bode well to start another business.
My case: What do you hope to do?
I hope to resolve my case with (HF) and be compensated for their mistakes and treatment.
Once this occurs, I will decide whether to continue with Group Physiotherapy.
If, this strategy fails. I would be open to being an investigator or working within the health industry as an investigative journalist.
My Case: What do you want from HF?
I beleive I did everything within my knowledge and capability to fulfil everything HF wanted.
I beleive HF unfairly targeted me, isolated me and discriminated against me as compared to favouring busines X. It treated all other practitioners differtently than me. I say this as (HF) did an audit on me 40 days before distributing educational information to the whole industry.
I invested 16 years and two million dollars into my business and was forced to sell under extreme duress.
I beleive that HF exercised an abuse of power, was aggressive and this directly caused the demise of my business. I should compensate for that.
My Case: What is stopping you from starting a business again?
When I started my business it took me almost 1 year to get a referral.
I have lost my innocense
I don't have the financial resources
I am not first to market
I don't have a clean collection of collecting contacts and mentors
I don't have my youthful energy.
Starting a business takes time and energy. I just don't have that.
The biggest reason, is the lack of confidence of working in a system that is unfair and unjust.
What do the acryonms and coding stand for on this website
(HF) - Generic code which stands for Health Fund
Jody- name used that replaces the real name
Business X- A mostly Class Physio business that as close by to my business, that I shared patients with.
[blanked out areas on the evidence on this website is either (HF)'s real name, it employees names, its identifying details, my previous business name and/or idetifying details and/or other peoples names hidden for confidentiality and legal reasons.
PHIO - Private Health insurance Ombudsman
APA - Australia Physiotherapy Association
HCCC - Health care Complaints Commission
APRAH-Australian Health Practitioner Regulation Agency