Phoodilicious

Ok, so now I need to research what bulk billing implies lol, thank you for your help. Maybe one day I will understand it all

EvannTel

A coupled of other points

Depending on your income circumstance etc, it may be preferable to ay the MLS and not have PHI. Lots f people do this.
Consultants and outpatients can be costly regardless of scheme. As pointed out a GP visit might easily cost $70 with only $35 odd back from Medicare. A consultant could cost several hundred with nothing back from PHI and only a small amount from Medicare. I've known many caught by this.

Like spouse of scouse, my oh also had spinal fusion in Perth 2 years ago and hospital expenses all private we're nil, she did have some consultant outpatient fees though. On the other hand she broke her arm 2 months ago - all costs including follow up with orthopedics was nil on Medicare.

Don't worry about it, as a new migrant it's probably one of the least of your worries. Whatever you do they wil get coin out of you ne way r another.

Swerv-o

The Medicare Schedule Fee is the cost that the government believe that a procedure or consultation should cost. So for example, they believe that a 7 minute GP consultation should cost $36. However, the schedule fees haven't been increased in many years, and they are not index linked.

For many reasons - staffing costs, insurance costs, property costs and greed - Doctors can elect to charge a fee higher than the Medicare schedule fee and operate as a private practitioner. Typically this is about $70 now, though was only $50 when I first arrived in 2006. So if you go to a private GP, they will charge you their fee of $70, and you will receive $36 back from Medicare and be expected to wear the remaining $34 yourself. In this case, you will receive 100% of the schedule fee back from Medicare.

This is extended to in hospital procedures, and visits to consultants in their rooms. My consultant charges $130 for an appointment, and I still only get $36 back from Medicare. Because this is not a hospital based cost, PHI is also not interested either - I end up being out of pocket by $94 a visit. In the case of specialists, you will receive 85% of the schedule fee from Medicare.

For most hospital based procedures, medicare will only pay out 75% of the scheduled Medicare fee, and your PHI will pick up the remaining 25%. Anything over that you will need to find yourself - this is known as The Gap, and this is where significant costs can occur. Some insurers will have arrangements with doctors that either reduce the gap fees down or negate them completely - these are known as 'Gap cover arrangements'. Many surgeons, however, refuse to have anything to do with Gap cover arrangements and continue to charge pretty much what they like. And of course, this is where it can become very expensive, and you may struggle to see the benefit of actually having PHI.



Bulk billing is when the provider agrees to honour the Medicare Schedule Fee, and not charge anything in excess of this. My GP does this, so my GP visits cost no more than signing the Medicare slip.

Generally you will find this in large urban medical centers, where there are a plurality of doctors, and you won't be guaranteed to see the same one each time. Though, in saying that, my GP is a sole practitioner, so I always see the same one - but there is definitely no touchy-feely doctoring - it's in and out in the allocated 7 minutes (or less). I actually prefer this, as it means I never have to wait long to be seen.

I hope this all helps explain the overly complex system. the entire system could really do with massive reform, but PHI is now so intricately linked to taxation and income that it would be very difficult to make it more user friendly.

I have always been of the opinion that if PHI covered more, then people would be more encouraged to take it up. As another poster said on here many years ago: "You don't expect to be worse off because you took out and used insurance." But this often ends up being the reality.


S

renth

True, also sometimes it's a mistake to answer "yes" the question "do you have private medical insurance?" The question really should be "do you want to be treated as a private patient?" I made that mistake as a wet behind the ears immigrant once and it cost me THOUSANDS in bills for my daughter's stay at Joondalup as result of a medical emergency.

They tired to trick my wife once later as well, we waited months as a public patient for some surgery for my daughter and the night before they rang my Mrs. and told her to report to the Private reception in the morning. She did and signed all the paperwork without reading it (natch!) and before you know it we were private patients again despite waiting months as public patients and receiving the exact same treatment in the exact same ward. Fortunately I argued the toss with them and they reversed it all out and we ended up paying nothing, they were very good about it but they didn't have to do it.

If the govt. ever mandated that you have to use your insurance if you have it then it will be a no brainer, I'd cancel it immediately.

Phoodilicious

Thank you very much for taking the time and effort to provide such useful and informative answers. I really appreciate it. I am certainly a little better informed and less confused and will probably take up a basic level PHI as necessitated by the 457 visa anyway in the first instance and then work out whether it makes sense to keep or whether the MLS is just worth paying instead.

Thanks all

spouse of scouse

Just a word of reassurance, I've lived in Oz all my life and still struggle to understand some aspects of health insurance

Wol

When you do, please PM me with an explanation. Use extra paper if required.

I've only been here nine years so I haven't a clue how it works yet.

Phoodilicious

Wol and Spouseofscouse - thank you, you made me feel much better, I was thinking I was being more dumb than usual in finding this subject overly complicated!

fish.01

To add to the above...this is what happens when seeing a private specialist, similar to the the UK. If you elect to see a public specialist at a public hospital outpatients clinic, similar to the NHS, it is totally free. Like the NHS though, if elective, you may have to wait depending on the hospital and the supply/demand of the speciality in question.

spouse of scouse

Good advice. I don't know about other hospitals, but a rellie is waiting for an endocrinology specialist appointment at Royal Perth hospital - 8 months.

While we're talking about all things medical, I had an MRI last Saturday night in a private billing practice - $1,000 and payment is required before you leave. I knew I wouldn't get anything back from my private health cover, and was told the Medicare rebate should be around $500. The young woman doing the accounts said my specialist could have ticked the 'bulk bill' box and it wouldn't have cost me anything, but added that Medicare have cracked down on specialists doing this and tell them only to bulk bill MRIs if the patient 'is in a really bad way' - I assume she meant financially.
If you're not in a really bad way before, you are after getting the bill!!

fish.01

Yes, and that's the thing...some waits are too long, depending on speciality and particular location and some are acceptable with many happy outcomes...so it really can pay to check rather than just going private by default.

This website lets you look up wait time specifics at your local hospitals: http://www.myhospitals.gov.au/. Unfortunately the waits are only listed for the elapsed time between being scheduled for an operation and having the operation.

itigo

There's something funny about MRIs if I remember? My physio ordered one for me as he didn't want to wait the 5 weeks for a specialist but that meant because a specialist hadn't ordered it, I had to pay the full amount. if I'd waited for a referral from the specialist it would have been cheaper. I think that's right?

I've just had major knee surgery and the bills are nearly all in. Paid 500 excess, 39.45 for the brace, 677 gap for the 2 procedures, 205 gap for the anaesthetist (which was bang on the quote and they actually took an hour longer than they thought so I was pleased it remained as the quote!).

Of course there are the pre and post op visits to the surgeon at 70 bucks a pop that I should get about 50 back on. And due to the amount of physio I had before, my PHI extras has just about run out so that'll be 56 a session x2 a week. Oh, and I've realised the surgeon had an assistant that said she'd charge no more than 300 out of pocket too. We pay 195 a month PHI but without it I'd have waited a year for this surgery, or would have had to pay nearer 10000 for it so it is worth it.

With all the above I'm guessing we'll hit the Medicare threshold again this year. That means that the percentage they cover rises as you've paid so much already. From memory it's 80% so all Drs and specialists visits become much cheaper. Unfortunately not the physio though. Just going to have to grin and bear that one!

renth

My Mrs has more surgery planned in a couple of weeks, we're going private. I'm guessing it will cost me about $1200 out of pocket.

Reason is much shorter waiting time plus much nicer hospital. Last surgery was public at Royal Perth which is a nightmare. I posted in a different thread about all the scummy bogans, the gangsters who came into the pre-op area to threaten a bloke with knives but my Mrs didn't tell me until yesterday about the woman in the bed next to her whose husband refused to leave when leaving time was over then went on to give him oral sex (behind the curtains, but even so!).

fish.01

Think if a doctor gives you a referral to the physio it might be covered.

spouse of scouse

I also thought that you couldn't claim a rebate from Medicare unless you were referred by a specialist, but I could quite easily be wrong. I was also referred by a physio for an MRI and he told me upfront I wouldn't get a rebate from Medicare due to him not being a specialist, but he sent me to a practice that only charged me $300. If I'd had a specialist referral, the charge would have been $500, with $200 refunded from Medicare (same practice, same procedure, same staff). Honestly, it's all such a crock!!

Re the Medicare threshold, does anyone know if that kicks in automatically from Medicare's end or do you have to keep track yourself and apply?