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Your Claims Cost team is working for you

10 March, 2016
article-claims

It is estimated that millions of dollars are lost each year within the Private Health sector through fraud and inappropriate claiming. CBHS has a no-tolerance policy for inappropriate claiming. Our Claims team meticulously assesses each and every claim that comes through our door, identifying and investigating any suspicious claims, while ensuring that members who've made legitimate claims receive their benefits in a timely manner. The Health Insurance Industry as a whole takes a dim view on inappropriate claiming as it places avoidable upward pressure on member premiums.

Some examples of inappropriate claiming are as follows:

  • Misuse of a Provider number: non-registered providers claiming under another provider’s details in order to receive a benefit from your Health Fund
  • Claiming for services not provided: an example of this behaviour might be claiming for both Massage and Acupuncture when only Massage treatment was provided
  • Claiming benefits from family membership limits: claiming a benefit against family members on your Card when they did not receive any treatment
  • Multi swiping of cards without your knowledge: providers or practice staff use your CBHS Membership Card to swipe multiple times; ‘fishing’ for higher benefits or other policy members’ entitlements

How you can help:

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  • Check if the Provider giving you the treatment or service is the same Provider specified on the receipt
  • Check the correct member or dependant/s name is on the receipt/s
  • Check the correct service/s is on the receipt eg Massage or Acupuncture treatment
  • Check to make sure your provider is licensed and recognised by CBHS for the treatment or service being provided: https://www.cbhs.com.au/members/claims-information/recognised-providers
  • In the case of Massage or Acupuncture, check your receipt for the therapist’s name – if you always see someone different but the same therapist’s name is on your receipt then you may have been treated by an unqualified therapist.
  • Check the therapist's office has a business licence or establishment licence. This can either be inside a private practice office or within a spa or clinic setting and is usually on a wall or desk.
  • Sign the receipt if using HICAPS/iSoft once you have checked and confirmed the information is correct.  Please see the example of a HICAPS receipt (source: www.HICAPS.com.au) explaining each area and what you are declaring to be correct.
  • If you notice any discrepancies please email the Claims Cost Team at claimscostteam@cbhs.com.au who will investigate your claim.
  • Always check your claims history – this is available via CBHS member services at www.cbhs.com.au/login. Once you’re logged in, go to Claims/Claims Status and History – complete details and tick box “include provider remittances”. This information will show the date of service, member name, type of service claimed, provider’s name, fee charged and benefit paid.

CBHS has a zero tolerance for fraud. Further information on Fraud Vigilance can be found on the CBHS website at https://www.cbhs.com.au/members/claims-information/fraud-and-vigilance

Some examples of the outcomes of our efforts over the last 12 months are:

  • Investigated and unauthorised a number of Providers for inappropriate billing practices
  • Removed certain providers from electronic claiming so that each claim is manually assessed by CBHS. This ensures each claim is accurate and legitimate
  • Cancelled members’ policies where they were found to be intentionally claiming inappropriately
  • Provided written notification, including the details of the type of fraud, to Australian Prudential Regulation Authority (APRA)
  • Reported policy holders to Police for committing fraud

Please advise CBHS of any anomalies as soon as possible and we will investigate – any anomalies may be found to be intentional / unintentional. Details can be emailed to claimscostteam@cbhs.com.au

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What Our Members Think

I joined as a CBHS member in 1978. Through many health events and challenges CBHS has always been there for me and my family. Their exceptional service over this time has always been appreciated.

- Jenny J

What Our Members Think

I've not long joined CBHS from another fund, but so far I've been impressed by the super helpful and friendly staff, the higher claim limits and rebates at a very competitive premium, and how easy it is to lodge manual claims through the app. Thanks CBHS - you've won me over! 😃

- Jessica B

What Our Members Think

What I love about CBHS is their customer service - friendly staff and always ready to help and email you the information you ask about. Keep up the great work!!!

- Linda S

What Our Members Think

I love CBHS as its so so easy to lodge a claim and whenever i need a question answered friendly consultant is one phone call away. The phone back option instead of waiting is brilliant!

- Rachel N

What Our Members Think

I have been with CBHS since I began at CBA 15 years ago...Now I have three beautiful children, one who has a disability. Our top extras cover has been really essential for his early intervention. I do love the ease of claiming online.

- Annette E

What Our Members Think

I am relatively new to CBHS and am loving it already. I worked for a CBA subsidiary a long time ago but was still eligible to join. So much better that the for-profit funds - our premium is only a little more and we pay a lower co-contribution and get great benefits. I am loving the massage rebate for my partner and gym rebate for me!

- David G

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I'm extremely happy with CBHS! I have been a customer for about six years. I think the price is reasonable. And i would refer you to my family and friends any day. Thank you CBHS!!!

- Karen W

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Love CBHS as I never have to doubt that they've got my back when I need it. Been through other insurers who have limited options or limits, yet cost the same or more.

- Mark F

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