Medibank Private, Calvary strike deal on ‘adverse events’

The stoush between Medibank Private and Calvary has been resolved, with an independent umpire to judge fault.

The public stoush between Medibank Private and national not-for-profit hospital group Calvary was resolved at the weekend through an agreement that will introduce an independent umpire to judge fault.

The list of Medibank’s 165 “adverse events” for which it will not pay remains, but individual incidents included in the list can be challenged by Calvary to be examined by an independent clinical review panel to ­determine fault.

If deemed to be the fault of Calvary, Medibank will seek to recoup hospital costs and the ­patient will not be billed the outstanding amount.

The agreement will mean the insurer’s four million customers will not face thousands of dollars in gap fees if treated at Calvary’s 11 private hospitals.

With the existing contract ­between the two parties due to expire today, the hospital group and insurer entered into “robust and challenging” negotiations last week. Medibank and Cal­vary yesterday declined to discuss the terms of the agreement. “There will be no out-of-pocket costs for Medibank customers,’’ a Medibank spokesman said.

A joint release from Medibank executive general manager Andrew Wilson and Calvary chief executive Mark Doran said the partnership would place both organisations in a “strong position” to help tackle the growing challenges facing Australia’s world-class health system”.