Private health insurers can access clinical records during audits. (ABC News: Maren Preuss)
Health insurers are entitled to ask a medical practitioner for a patient's notes to ensure the correct procedure item numbers have been billed.
However, hospitals and allied health providers are raising concerns about insurers asking providers for their patients' full clinical history.
Private health insurers are potentially seeking too much access to patients' confidential medical information, through what has been described by the Australian Private Hospitals Association as "aggressive" audit practices.
Permission to access medical records is typically baked into the terms and privacy policy, which essentially grants the insurer permission to collect wide-ranging data on their customers — from security camera vision in their shopfronts, to personal social media posts.
Under agreements with patients and hospitals, insurers are entitled to ask a medical practitioner for a patient's notes relating to an episode of treatment, to ensure the correct procedure item numbers were billed.
But hospitals and allied health providers warn there have been cases of insurers asking providers for their patients' full clinical history.
It comes after ABC News reported concerns about claims of anti-competitive behaviour by health insurer Bupa and broader industry allegations of misuse of market power.
One physiotherapist, who did not want to be identified for fear of retribution by insurers, told ABC News he had been subject to an aggressive audit twice by Bupa.
Bupa has been criticised for its auditing practices. (ABC News: John Gunn)
He said during one audit, Bupa asked for the entire clinical history of his Bupa customers.
The physiotherapist wrote to his patients to seek their permission to release the documents and two-thirds refused.
When he told the insurer this, he said he received a letter stating the company wanted those details irrespective of patient consent and told him it was in his agreement with the insurer to be a preferred provider.
Industry experts told ABC News that when patients sign up to private health insurance, the terms of their insurance do allow for their records to be accessed during audits.
When the physio was told by the professional regulator, the Australian Health Practitioner Regulation Agency, that he was not allowed to release the information because patients had not granted permission, he claims the insurer threatened him with having to repay up to $300,000 in benefits.