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Old Jul 15th 2017, 4:48 am   #1
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Default The cost of a private medical procedure

Quick cautionary tale.

We have had top-level private medical cover since arriving in Aus 7 years ago.

Currently I'm covered by my employer at a basic level and I pay to increase this to top-cover and also my wife pays for top-level cover, this costs us about $400 pm.

Recently one of us needed urgent surgery and although it was a minor one-day procedure I thought people would be interested in the costs.

When taking into account surgeon, anaesthetist and hospital fees the top line fee was around $16,000. Much of this we had to pay then claim back from the health fund and Medicare, on one occasion we went to see the doc and the receptionist said "I was about to post your bill, would you like to pay now", err yeah, sure I said, it was $5,000. As many of the doctors charged above standard rates for their procedures after all claims have been paid we are out-of-pocket by approx. $3,500.

On the day of the procedure I got a call from the hospital saying the health fund might have a problem with our cover, it turned out to be an error on their part but it added stress and could have stoped the operation. It was new to me to encounter healthcare where the first question in all cases was "how will you pay"

The process of claiming it all back was pretty complicated and only now, about 2 months afterwards is it all done.

Thing is, I thought my private (remember this is top-hospital cover) insurance would mean we would have minimal expense in the event of a claim, guess I was wrong. Fortunately we can afford it with minimal impact to ourselves but it was a surprise non-the-less!

Now I hear that the tax rebate for medical cover may be going away I'm wondering if its worth it at all.
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Old Jul 15th 2017, 5:23 am   #2
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Default Re: The cost of a private medical procedure

Quote:
Originally Posted by freebo View Post
Quick cautionary tale.

We have had top-level private medical cover since arriving in Aus 7 years ago.

Currently I'm covered by my employer at a basic level and I pay to increase this to top-cover and also my wife pays for top-level cover, this costs us about $400 pm.

Recently one of us needed urgent surgery and although it was a minor one-day procedure I thought people would be interested in the costs.

When taking into account surgeon, anaesthetist and hospital fees the top line fee was around $16,000. Much of this we had to pay then claim back from the health fund and Medicare, on one occasion we went to see the doc and the receptionist said "I was about to post your bill, would you like to pay now", err yeah, sure I said, it was $5,000. As many of the doctors charged above standard rates for their procedures after all claims have been paid we are out-of-pocket by approx. $3,500.

On the day of the procedure I got a call from the hospital saying the health fund might have a problem with our cover, it turned out to be an error on their part but it added stress and could have stoped the operation. It was new to me to encounter healthcare where the first question in all cases was "how will you pay"

The process of claiming it all back was pretty complicated and only now, about 2 months afterwards is it all done.

Thing is, I thought my private (remember this is top-hospital cover) insurance would mean we would have minimal expense in the event of a claim, guess I was wrong. Fortunately we can afford it with minimal impact to ourselves but it was a surprise non-the-less!

Now I hear that the tax rebate for medical cover may be going away I'm wondering if its worth it at all.
After a similar experience and then having a further experience but relying entirely on the public system, we abandoned private health for hospital cover and just kept extras.
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Old Jul 15th 2017, 11:12 pm   #3
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Default Re: The cost of a private medical procedure

Quote:
Originally Posted by freebo View Post

The process of claiming it all back was pretty complicated and only now, about 2 months afterwards is it all done.

Thing is, I thought my private (remember this is top-hospital cover) insurance would mean we would have minimal expense in the event of a claim, guess I was wrong. Fortunately we can afford it with minimal impact to ourselves but it was a surprise non-the-less!

Now I hear that the tax rebate for medical cover may be going away I'm wondering if its worth it at all.
It will depend on your health fund (for the hospital fees) and the surgeon/anaesthetist.

I had knee surgery nearly 4 years ago - hospital fees were paid direct by health fund (apart from my excess, which I paid at admission), surgeon and anaesthetist fees I had to pay upfront and then claim back the medicare part, medicare then forwarded the rest of the claim to the health fund for refund.

Out of pocket - $500 excess to hospital, about $1500 for surgeon/anaesthetist. The surgeon and anaesthetist weren't in any kind of 'scheme'.

Last December, I had to have a gynaecological procedure in day surgery. My gynae and his anaesthetists operate under 'known gap' where there's a maximum they can charge as a co-payment.

Had to pay my $500 to the hospital on admittance, then just pay the co-payment afterwards - about $300 to the gynae, $100 to the anaesthetist. They dealt with the health fund.

End of June, I had to go back in for a hysterectomy. Same gynae, different anaesthetist, but still operating under the 'known gap'. 4 day stay in hospital - no charge because I'd paid the yearly excess already. $400 for the gynae, $180 for the anaesthetist, they dealt direct with the health fund/medicare for the rest.

Last weekend, had to go back in as an emergency admittance due to complications from previous op. Small procedure under anaesthetic necessary. No charge for the 4 day stay from hospital (although because they were unable to check our status with the health fund, Mr Dreamy had to sign a waiver saying we'd be responsible for the $2000 a night fee if there was a problem... no stress there then!!). No charge from surgeon or anaesthetist.

So yes. I think you have to pick and choose where and when you go private, and if it's worth having hospital or just to go for the extras to avoid the levy. For me, because my hysterectomy was precautionary/preventative, it was definitely worth the lack of stress and worry to go private and just get it done, rather than wait an unknown amount of time on the public lists.
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Old Jul 19th 2017, 7:13 am   #4
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Default Re: The cost of a private medical procedure

I have had 2 private surgeries. The waiting times public would have been long, up to 2 years to even see a public specialist let alone the surgery. I am actually still on the wait list for a appointment, years after the private surgery.

Private. Imagine you are a vehicle, you have to shop this around Sorry but its true, you price your surgery around.

But firstly you go to your health fund and get their Members choice, ( Bupa name) hospital, surgeons, who will bill the fund direct. Anesthetist who by the way will almost always have a gap.

By doing this I have had both surgeries in very nice Private hospitals, own room with ensuite, top surgeon. The cost, excess in my case 250, about 300 for the anesthetist and no out of pocket for the surgery except in room consults prior to the surgery. Specialist fee minus the medicare pittance = gap of around 200.

When I badly broke my leg it was an emergency I went public. Even that I waited 6 DAYS for the surgery, thats correct, it was temporaily set and I was bedridden for 6 days till the pins and plates went in. Nambour hospital if anyone doubts this. By some stroke of a miracle I was in a room with 2 beds, most rooms were wards of 8. I was on a drip so no food till after 6/7pm when someone would tell me the obvious that I was too low on priority to make the surgery list that day, then I could celebrate with a hospital sandwich.

If I gave up private I would pay extra tax, however the premiums of 222 about six years ago are now 336 a month, hosp and 75 % extras, but some surgery exclusions like knee, hip, psychiatric, gastric banding.
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Old Jul 19th 2017, 7:23 pm   #5
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Default Re: The cost of a private medical procedure

Agree about the necessity to shop around, both for your private health fund and for anaesthetists.

I can only talk about HBF in WA, but I found them to be great. I had 3 surgeries in the few years before moving to the UK. I already knew that the private hospital I wanted to go to was fully covered by my policy, apart from a once per year $200 excess.

Two of the surgeries were planned so I had the time to call my health fund and they emailed me the list of anaesthetists that they covered me for with no gap, and who worked in the hospital I was booked into. I already had my own neurosurgeon, who worked there and his fee was also covered 100%.

The other surgery was an emergency, and although my (same) surgeon's fees were fully covered, I do remember a rather surreal bedside meeting with the anaesthetist who told me very directly that his fees would be $400 more than I could recover from HBF, and I had to sign a form saying that I agreed to this. With a morphine IV line in and still in horrific pain, I wasn't about to argue.

No wonder people get confused with private health cover and care in Oz, it's the most hideously complicated system and it doesn't help that each health fund seems to have quite different rules.

As an example - for each of in-patient stays above, I only had to pay $40 total for all the radiology and pathology services I had (and they were numerous). $40 per hospital stay is the maximum I pay with my health fund. In contrast, my sister, who's with Medibank Private, had a bill of almost $3,000 for radiology and pathology after her 3 hospital stays for cancer treatment.

I always try to respond to BE members querying public and private health care costs in Australia, and have written screeds about it. But because there's so much variation in terms of location, hospitals, health funds, what's covered and what's not, it's impossible to give people a clear, concise 'fact sheet'. A gigantic PITA is what it is!!
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Old Yesterday, 4:04 am   #6
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Default Re: The cost of a private medical procedure

Quote:
Originally Posted by freebo View Post
Quick cautionary tale.

We have had top-level private medical cover since arriving in Aus 7 years ago.

Currently I'm covered by my employer at a basic level and I pay to increase this to top-cover and also my wife pays for top-level cover, this costs us about $400 pm.

Recently one of us needed urgent surgery and although it was a minor one-day procedure I thought people would be interested in the costs.

When taking into account surgeon, anaesthetist and hospital fees the top line fee was around $16,000. Much of this we had to pay then claim back from the health fund and Medicare, on one occasion we went to see the doc and the receptionist said "I was about to post your bill, would you like to pay now", err yeah, sure I said, it was $5,000. As many of the doctors charged above standard rates for their procedures after all claims have been paid we are out-of-pocket by approx. $3,500.

On the day of the procedure I got a call from the hospital saying the health fund might have a problem with our cover, it turned out to be an error on their part but it added stress and could have stoped the operation. It was new to me to encounter healthcare where the first question in all cases was "how will you pay"

The process of claiming it all back was pretty complicated and only now, about 2 months afterwards is it all done.

Thing is, I thought my private (remember this is top-hospital cover) insurance would mean we would have minimal expense in the event of a claim, guess I was wrong. Fortunately we can afford it with minimal impact to ourselves but it was a surprise non-the-less!

Now I hear that the tax rebate for medical cover may be going away I'm wondering if its worth it at all.
Our recent experience:
My wife recently needed a minor day surgery procedure. Our health insurance is through HBF. Everything went smoothly, no hassles at all. Total out of pocket expenses have been less than $75. Nearly everything was handled by HBF (apart from one minor pharmacy bill). I have found HBF to be excellent over all the years we have used them and when I think about it, we have probably taken more out of the system than we've paid in

I'm very happy with the health system in Australia where you can rely on Medicare for anything major or emergency and private health cover for minor stuff and the rest. Yes, the private insurance setup can be overly bureaucratic at times, but overall the system works pretty well
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Old Yesterday, 10:25 am   #7
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Default Re: The cost of a private medical procedure

Quote:
Originally Posted by jad n rich View Post
I have had 2 private surgeries. The waiting times public would have been long, up to 2 years to even see a public specialist let alone the surgery. I am actually still on the wait list for a appointment, years after the private surgery.
If you've had the surgery then why are you still on the wait list to see a specialist? You have had the procedure so no longer need the appointment! Maybe if you let the clinic know you don't need to see the specialist they could bring in someone who actually does need it.

Last year I worked on a project for the WA Health Department looking into cutting wait times for gastroenterology procedures in WA. One of my jobs was to contact close to 4000 people to see whether they still needed the procedure they were waitlisted for. Nearly 1600 people were removed from wait lists, about 30% of these had already had it done privately. Wait times went from over 2 years down to a matter of a few months. Project update from November 2016 here .
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