Complaints and Disputes

1. Understanding Complaints and Disputes

Complaint: Any concern, issue, question, or expression of dissatisfaction a customer may have regarding Smart Compare Health Insurance’s service, advice, or processes.

Dispute: If a customer is not satisfied with the outcome of their complaint, they may escalate it to a formal dispute for review by senior staff.

2. Why You Should Contact Us

We encourage you to raise any concerns so we can:

  • Resolve issues quickly and with minimal inconvenience

  • Prevent similar issues from occurring in the future

  • Ensure all customer feedback is heard and treated fairly

  • Provide guidance even where the issue relates to a third-party provider such as an insurer

  • Offer clear pathways for escalation if a resolution cannot be reached internally

3. How to Raise a Concern

You can raise a complaint or concern using the following channels:

If your concern relates to a health fund, you may also raise it directly with the insurer.

Our team will confirm the details of your complaint to ensure accuracy before proceeding.

4. How We Handle Complaints

We follow a structured process to ensure all complaints are handled fairly and efficiently:

Step 1 – Initial Review
We review your complaint as soon as possible upon receipt.

Step 2 – Team Escalation
If not resolved immediately, the matter is escalated to a team manager within 3 business days.

Step 3 – Resolution Review
If required, our Resolutions Manager conducts a final review and determines the outcome.

You may also contact the Resolutions Manager directly at complaints@smartcompare.com.au for confidential handling.

5. Outcome and Communication

  • Most complaints are responded to in writing within 10 working days

  • If delays occur, we will keep you informed and provide an updated timeframe

  • The majority of matters are resolved within 21 working days

6. External Dispute Options

If you are not satisfied with the outcome, you may escalate your complaint externally:

  • Review by Smart Compare Health Insurance’s Managing Director

  • Private Health Insurance Ombudsman (PHIO) – free independent service

Contact details:
Phone: 1300 362 072
Email: info@phio.org.au
Post: GPO Box 442, Canberra ACT 2600
Website: www.ombudsman.gov.au

7. Learning from Complaints

All complaints are recorded and reviewed to help improve our services.

We use customer feedback to:

  • Improve internal processes and systems

  • Provide additional staff training where needed

  • Reduce the likelihood of recurring issues

  • Strengthen overall service quality

Our commitment is to fairness, transparency, and continuous improvement in every customer interaction.