ASO Pushes Back on Insurers as Reform Bill and AMA Position Statement Sharpen the Debate

The Australian Society of Ophthalmologists (ASO) has moved on two fronts this month to hold private health insurers to account, backing a landmark AMA position statement on contracting practices while welcoming key provisions of a new federal transparency bill, though the peak body is making clear that neither goes far enough.

AMA Position Statement Gets ASO Backing

On 5 February, the ASO threw its support behind the Australian Medical Association's newly released Position Statement on Principles for Private Health Insurer Contracting with Medical Practitioners, describing it as long overdue.

ASO President Dr Peter Sumich pulled no punches in his assessment of the current contracting landscape. "The fox is in the hen house, and nobody seems to care. Private health insurers are laws unto themselves, wheeling and dealing and jumping through loopholes on their way to $2 billion profits a year," he said.

The ASO's concerns centre on several systemic issues it says are directly impacting the delivery of specialist eye care. These include insurer practices that risk interfering with clinical decision-making around treatments, procedures and prostheses; bundled contract arrangements that can undermine the independence of specialist care; confidentiality clauses that shield contract terms from appropriate scrutiny; benefit rates that have failed to keep pace with the real costs of delivering quality care; and so-called "take it or leave it" contracts that exploit the power imbalance between large insurers and individual practitioners.

"Ophthalmology involves highly specialised surgical procedures where clinical judgement must remain paramount," Dr Sumich said. "Patients trust their ophthalmologists to recommend the best treatment options, and this decision-making must not be compromised by insurer-imposed restrictions."

The ASO called on the Federal Government to act on the AMA's recommendations and implement meaningful regulatory reform across the private health system.

New Bill Welcomed — With Conditions

Just one week later, the ASO welcomed a separate but related development: the introduction of the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026.

The Bill proposes to make specialist fees publicly available through the federal government's Medical Costs Finder platform, enabling patients to compare costs and make more informed healthcare decisions. It also moves to outlaw the controversial practice of product "phoenixing" where insurers shut down an existing policy and reopen a near-identical product at a substantially higher premium, effectively bypassing the regulated Premium Round process and would require Ministerial approval for new products or changes that reduce existing cover.

The ASO, a co-signatory to the AMA's National Informed Financial Consent Guide, said it supported any measure that improves patients' understanding of their out-of-pocket costs, but stressed the data must be presented with appropriate context.

"If this tool genuinely helps patients anticipate their out-of-pocket costs, then we're all for it. But the data must be presented accurately, with proper context, so patients understand why specialists charge what they do," Dr Sumich said.

On phoenixing specifically, the ASO's response was unequivocal. "We have been calling for phoenixing to be stamped out for a long time, and we're pleased the Government has listened. This is exactly the kind of insurer accountability that patients need," Dr Sumich said.

A Consistent Message: Transparency Must Run Both Ways

Across both statements, the ASO is prosecuting a consistent argument: that the scrutiny now being applied to specialist fees must be matched by equivalent transparency obligations on insurers themselves.

"If we're talking about transparency, it can't be one-sided," Dr Sumich said. "Patients deserve to know exactly what their private health insurer is doing with their premium dollars. How much is being returned to hospitals and practitioners who actually deliver care? Insurers need to be held to the same standard of transparency being asked of doctors."

With premium hikes forecast for 2026 and growing pressure on the private health system, the ASO's dual intervention signals that ophthalmologists intend to remain a vocal force in the policy debate and that the profession's patience with the status quo is wearing thin.