Disputes and complaints

CBHS is a signatory to the Private Health Insurance Code of Conduct. We are committed to upholding the Code’s principles of fairness, transparency, and accountability in all aspects of our complaints handling process. For more information about the Code, visit: privatehealthcareaustralia.org.au/codeofconduct

What is a complaint?

Complaint

An expression of dissatisfaction made to CBHS or about our products, services and staff, where a response or resolution is explicitly or implicitly expected or legally required. This also includes complaints about the CBHS Complaints Handling Process. This policy is restricted to complaints and/or disputes by members and or members of the public about CBHS.

It includes, but is not limited to, dissatisfaction with our:

• customer service
• actions or decisions
• inaction or delay
• policy or processes.

Feedback

Opinions, comments and expressions of interest or concern, made by a member or a member of the public, directly or indirectly, explicitly or implicitly, to or about CBHS and its products, services, or complaint handling where a response is not explicitly or implicitly expected or legally required.

Feedback can be about:

• desire for increase/different benefit limits
• changes to product inclusions
• suggestions for website or app.

Occasionally we receive negative feedback in the form of opinions, comments and expression of interest or concern about our products, services, or interactions, which may not require a resolution or formal follow up. The complaints handling framework does not apply to feedback of this nature unless we decide to manage it in the same way as a complaint.

Resolution process

We are committed to resolving any complaints as quickly and efficiently as possible. If you raise a complaint with us, we will aim to resolve it during your initial contact, such as over the phone or in person. For more complex cases that require further investigation, we will escalate your complaint to our dedicated Member Resolutions Team. A case manager from this team will reach out to you within one working day to acknowledge your complaint, provide their contact details, and outline a timeframe for resolution.

We aim to resolve all complaints within 3-5 working days. However, if we anticipate delays, we'll notify you with an explanation and provide a revised timeframe. In urgent situations, such as those involving a threat to life or financial hardship, we will prioritise your case.

If we have not met the agreed timelines or processes, we encourage you to contact us directly at complaints@cbhs.com.au to discuss further steps.

Upon resolution, we will explain the reasoning behind the proposed solution. If you remain dissatisfied, we will inform you of your right to seek an external review.

Remedies and outcomes

When deciding how to resolve your complaint, we’ll consider what would be fair and reasonable in the circumstances. Remedies we may apply include an apology, additional information, financial compensation where appropriate, referral or other remedy we consider appropriate to the circumstances. 

Internal review

If you’re unhappy with the initial outcome of your complaint provided by our Member Resolutions Team, you can request another review of your complaint, which will be handled by a different member within the Member Resolutions Team.

If you're requesting an internal review, please provide reasons explaining why you were dissatisfied and include any new or additional information that will support your complaint.

You'll be advised whether we'll conduct an internal review, or we'll refer you to an external review. Internal reviews are to be resolved within 10 working days. If it's taking longer than 10 days to resolve your internal review, we'll follow up with you and advise of an expected timeframe.

External review

If you’re not satisfied with the outcome of your complaint, you can escalate the matter to the independent dispute resolution service offered by the Private Health Insurance Ombudsman (PHIO). The Office of the PHIO protects the interests of consumers by resolving complaints through an independent and impartial complaint handling service. 

Website: www.ombudsman.gov.au
Email: phi@ombudsman.gov.au
Phone: 1300 362 072 (option 4 for private health insurance)
Mail: GPO Box 442, Canberra ACT 2601

If your complaint relates to privacy or the handling of your personal information and you are not satisfied with our response, you may escalate your complaint to the Office of the Australian Information Commissioner (OAIC) 

Website: www.oaic.gov.au
Phone: 1300 363 992
Mail: GPO Box 5288 Sydney NSW 2001

Expectation of complainant

Complainants are expected to behave in a reasonable manner.

Unreasonable conduct of a complainant is defined as any behaviour by a person which, because of its nature or frequency, raises substantial health, safety, resource, or equity issues for the people involved in the complaint process.

Unreasonable persistence, unreasonable demands, unreasonable lack of cooperation, unreasonable arguments, and unreasonable behaviour will not be accepted, and may result in the following:

• Restrictions placed on how and when you can contact CBHS
• Complaint matter will not be actioned
• At the discretion of the COO, the policy may be cancelled.

Vulnerable individuals

CBHS is dedicated to assisting members who may experience financial or personal difficulties impacting their ability to make timely payments. CBHS encourages vulnerable individuals to contact us to discuss what assistance is available.

CBHS is committed to providing accessible complaint handling for all members, including those with disabilities or language needs. Please let us know if you require assistance.

Authority to Act

Following appropriate identification, authority can be granted by a member to a third party to act on their behalf regarding a specific matter or on an ongoing basis.

Fees

There are no fees for lodging a complaint with us.

Your privacy

Throughout the complaint process, we will protect your privacy and handle your personal information confidentially and in accordance with our Privacy Policy.