Private insurers face backlash over requests for patients' full medical histories

Australian private health insurers are accused of expanding audit requests beyond the narrow scope allowed by patient agreements, seeking full clinical histories rather than just episode-specific notes. A physiotherapist described two intensive audits by Bupa, during which the insurer demanded all records of its members, despite two-thirds of patients declining permission; the insurer claimed contractual rights and threatened large repayments.

Similar grievances have emerged from dentists, who say auditors lacking medical training were sent to reclassify claims, and from ophthalmologist Andrew Chang, whose court case against Bupa ended with the insurer ordered to pay costs. Industry bodies such as the Australian Private Hospitals Association and the Independent Dentist Network label the practice “aggressive” and potentially illegal, while legal scholars argue that contracts cannot override statutory confidentiality obligations. Insurers maintain the audits are routine, proportionate, and necessary for payment integrity, but providers warn of rising operational burdens and patient dissatisfaction.