Medibank Private and Calvary Health Care have continued to trade blows as the August 31 deadline for a contract renewal edges closer.
In July, Medibank initiated termination proceedings after months of unsuccessful negotiations and a disagreement about safety criteria and market rates.
The breakdown in mediation means thousands of ACT patients may be forced to pay more for hospital care unless the two parties can reach a final agreement.
On Thursday, Calvary chief executive Mark Doran said Medibank’s actions would restrict hospital action for patients and the clinical autonomy of doctors.
“Let us be clear, Medibank is reducing its payments for members while in a Calvary hospital leaving its members to pay the difference,” he said.
“This could be somewhere between 15 percent and 25 percent of its members’ costs whilst in hospital.”
But a Medibank spokesman said this was not true and the health insurer would always pay for member’s treatment even if they did not have a contract with the hospital.
“The difference is, without a contract a hospital can choose to charge our members additional out of pocket expenses, he said.
“Many don’t, so if Calvary chooses to do so we want our members to call us so we can do what we can to help.”
Around 4700 Medibank Private members used the territory’s Calvary hospitals last year, at Bruce and John James. There are no Medibank-contracted alternative hospitals for obstetrics and psychiatry.
The health insurer was sold by the federal government in a $5.7 billion float last year.
The Medibank spokesman said the company was not seeking to interfere with the autonomy of doctors and only sought modest changes to “avoidable expenses resulting from unfortunate mistakes”.
“We only focused on those mistakes where there is good evidence that they can be prevented in hospital, such as falls and bedsores,” he said.
Mr Doran said Calvary supported the view of Australian Medical Association president Professor Brian Owler that doctors should decide what patients need, not insurance companies.
“Medibank is simply making good on a promise to ‘flex its muscle’,” he said.
“This is not an approach that gives us confidence that Medibank will fund appropriate care for its members now or in the future.”
Should an agreement not be reached by August 31, Medibank members can still receive treatment although Calvary many charge them with additional costs.
A Medibank spokesman said those who had already booked treatment will have extended cover beyond August 31, from two months to nine months for pre-booked pregnancy care.