Bupa Health Insurance Faces A$35 Million Fine in Australia for Denying Legitimate Health Insurance Claims

British health insurance company Bupa has agreed to pay an A$35 million (US$23 million) penalty in Australia after admitting to “unconscionable conduct”. The Australian Competition and Consumer Commission (ACCC) found that Bupa had wrongfully rejected valid health insurance claims made by patients over a five-year span from May 2018 to August 2023.

According to the ACCC, Bupa's actions were misleading and deceptive, particularly in cases involving “mixed coverage” claims. These typically occurred when patients underwent multiple procedures during hospital visits. If even one of those procedures wasn’t covered by the customer’s policy, Bupa denied the entire claim, regardless of whether other components were valid.

The watchdog said this resulted in thousands of customers paying out of pocket, upgrading policies unnecessarily, or forgoing treatment due to cost concerns. ACCC Chair Gina Cass-Gottlieb highlighted the harm caused, stating that the conduct left many consumers unable to afford or access care they were entitled to.

Bupa has admitted to the misconduct and has already paid A$14.3 million in compensation related to over 4,100 claims and eligibility checks. Nick Stone, head of Bupa Asia Pacific, said, “This should never have happened.”

Bupa Asia Pacific — covering Australia, New Zealand, and Hong Kong — was the company’s largest division in 2024, contributing 37% of revenue and nearly 50% of underlying profit. Bupa entered the Australian market in 2002 and has grown to become the second-largest private health insurer, serving 4.5 million customers.

The Australian government supports private health insurance to reduce pressure on the public system, which has increased the uptake of such policies.

In addition to health insurance, Bupa also operates aged care and health centers in Australia. It has recently been linked to a potential acquisition of Healthscope, a private hospital operator that entered administration last month. Bupa has not commented on whether it will pursue this takeover.