Private health insurer Bupa is facing a proposed $35 million penalty after admitting to misleading thousands of customers about their health insurance entitlements and engaging in unconscionable conduct over five years.
The Australian Competition and Consumer Commission (ACCC) has filed proceedings in the Federal Court against Bupa HI Pty Ltd, alleging multiple breaches of Australian Consumer Law.
ACCC and Bupa will jointly ask the court to impose the penalty and related orders, though the court will determine the final outcome.
Bupa admitted it had falsely told customers they were not entitled to benefits for certain claims, when they were in fact eligible for partial cover.
“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,” said ACCC Chair Gina Cass-Gottlieb.
System Failures Led to Claim Rejections
Most affected claims involved hospital procedures combining covered and non-covered treatments. Instead of paying for the eligible part, Bupa rejected entire claims.
Between May 2018 and August 2023, the misrepresentations occurred both before treatment—during coverage checks with Bupa staff—and after, through flawed automated systems.
From June 2020 to February 2021, Bupa also stopped manually reviewing some claims it knew might have been wrongly rejected, a practice it now admits was unconscionable.
According to the ACCC, these failures stemmed from inconsistent training and system programming errors that led to thousands of legitimate claims being declined.
Bupa has repaid $14.3 million so far across more than 4,100 affected claims, including compensation, interest, and goodwill payments.
It has also given a court-enforceable undertaking to continue remediation.
The ACCC noted the fallout extended beyond financial loss. Some customers reportedly postponed or cancelled essential procedures, leading to pain, distress, and avoidable complications.
Bupa Issues Apology, Promises Reforms
Bupa has apologised for the failures and said it is working to prevent recurrence.
“We are deeply sorry for failing to get things right for our customers and are saddened by the impact this has had on them and their families. This should never have happened,” Bupa APAC CEO Nick Stone said in a statement to The Epoch Times.
“Our priority has been to communicate and compensate our affected health insurance customers and providers, along with putting in place measures to help ensure this does not happen again.”
The company said it will continue compensating affected customers under its remediation program while the court considers the ACCC’s proposed penalty.
