Medibank Gold customer faces rejection in urgent ambulance case

However, when the couple from Victoria's northeast received a $2000 ambulance bill in the mail and claimed it with Medibank, it was rejected.

"I told them we've got gold cover for ambulance services during an emergency; this was an emergency - what's going on?" she said.

"They are exploiting a loophole."

It was just after midnight when Michael Green woke up struggling to breathe.

Mrs Green raced to the car and drove him to Myrtleford Urgent Care Centre, navigating through thick fog in the early hours of Friday, August 25.

Concerns darted through her mind: "he has a history of bad asthma," she thought.

"We're new to the area, who knows what's in the air that's bugging him - he might've come down with a bad cold - he's been working really hard doing all the bus trips up to Mount Hotham, he might just be exhausted."

They arrived at the urgent care centre and were treated immediately.

"He was deteriorating rapidly," Mrs Green, a nurse between jobs who had just moved to the area from South Gippsland, said.

"They said it looked like some sort of throat closure, possibly caused by an abscess or tumour - you could feel something around his throat.

"He was potentially going into septic shock, so they were jamming as many antibiotics as possible into him to try and tackle that."

The doctor suggested flying Mr Green to Melbourne via air ambulance, but that was impossible due to the fog.

Instead, an emergency ambulance rushed him to Wangaratta Hospital, where an ENT specialist assessed him before he was transferred again to Albury Base Hospital for an endoscopy procedure.

The problem lies in the Myrtleford Urgent Care Centre to Wangaratta Hospital transfer.

Medibank catagorised it as a public hospital to public hospital transfer, putting the responsibility on the hospital to pay for the transfer.

It's true, Alpine Health Myrtleford is a public hospital; however, because the hospital's urgent care centre isn't an emergency department and is unfunded, the transfer costs for an emergency ambulance aren't covered.

The private health insurer is meant to pay it.

"To me, it's like I took Michael to the local GP clinic after hours and the GP called an ambulance," Mrs Green said.

"That would be covered by private health insurance."

IN OTHER NEWS:

After being rejected by Medibank initially, Mrs Green rang Myrtleford Urgent Care Centre where a nurse explained that when you come to an urgent care centre, it's not publicly funded, and the bill falls on the patient.

"But they (Medibank) know this," the nurse at the urgent care centre said. "Go back and tell them this is an urgent care centre, so technically, not a public hospital."

Mrs Green then called Medibank back twice about the claim. Both times the matter was handed over to the customer service representative's supervisor. Both times, the claim was denied.

"It's discrimination against rural people," Mrs Green said.

"Urgent care centres tend to only be at public rural hospitals. Healthcare is meant to be universal, so regardless of whether you are in a rural area or a city, you're meant to be able to access the same services.

"Medibank Private have decided, and willfully so, that urgent care centres don't matter - people will be having this problem all the time."

"A social worker said to me on Twitter, 'I have people coming to me with these bills all the time; they can't afford them and have to make payment plans.

"So they know about this so-called loophole and haven't closed it."

Mrs Green took to Twitter (now X) and shared her story.

Indi MP Helen Haines commented on the post, saying, "Please email my office with full details so my team can investigate".

ACM's The Border Mail called Medibank about the matter, and after being told about the story, they reviewed the claim and decided to cover the full $2000 hospital transfer.

"We're really sorry for the stress that this caused and pleased that we were able to resolve it with the customer earlier this week," a Medibank spokesperson said.

"This was an admin error and we're improving our processes so that our team is better equipped to deal with a similar situation in the future."

Mrs Green still wanted to get the story out into the public to warn others who may find themselves in a similar situation, saying, "this problem is systemic".

"Nothing will change if we are all just plugging away, arguing privately," she said.

"There are people that through natural attrition will go, oh stuff it, I'll just pay it and go on a payment plan; I haven't got the energy to fight this.

"But that's what they want to happen, and it's not good enough.

"Private health insurers are on notice, and consumers will not put up with being deceived."

After the endoscopy at Albury Base Hospital, doctors found that scarring in Mr Green's throat caused by a condition known as Barrett's esophagus is what caused the problem.

He is now okay.