sormesher

Hi there,
I'm looking in to getting private health. We already have an
Extras only cover but think some hospital may be a good idea too.
I'm on a public wait list as urgent and have been waiting seven months already. I know I have wait periods but it's times like this it would be handy to at least see what maybe wrong.
Anyway can any one provide some examples of what your out of pocket expenses were for hospital investigations?
Thanks

fish.01

We have never paid anything though many do.

We always ask to be taken on as a No Gap patient and they have always agreed and we have just paid the agreed excess on our policy. This is for IVF, two childbirths and a few small unrelated day procedures. We did pay a few hundred to some other specialists used in the childbirths - pediatrician and anaesthetist.

Remember this is for in-hospital treatment only which is all private hospital insurance covers. The consultation fees charged by the private specialist before and after the hospital treatment, and sometimes also management fees, are significant but private hospital insurance has nothing to do with these because they are not incurred in a private hospital and private hospital insurance does not cover them.

DadAgain

..and theres the rub - that sounds like a serious gap to me.

Our daughter had minor tear duct surgery. All was covered by our health insurance. but our costs were:
3 consultation appointments (3x 10 minutes) = $450 ($120 back from Medicare)
Consultant costs for surgery = $0 (all covered)
Hospital fees = $0 (all covered)
Anaesthist fees $600 ($200? back from Medicare)

So all up this minor procedure cost us around $700. (Note it takes 'top level cover' to reduce these costs to $0 as shown above - any less and there'd be excesses for hospital fees and surgeons costs too)


As far as childbirth is concerned my data is out of date but costs are in the region of:

Birthing Management fee: $5000 (not covered by insurance)
Pre-natal consults: $1100 (10 x $150 with $40 back from Medicare)
Hospital fees: $0 (covered by insurance)
OBGYN fees: $0 (covered by insurance)
Aneasthetist: $200-$1000 depending on luck of the draw and whether you end up with drug free/epiduraled/full c-section.

Alternatively public birth suites offer a superior service (midwife driven - so SAFER) for no out of pocket expense. The downside is you'll have to hang around for a while in a waiting room for all of those pre-natal checkups!

fish.01

Yeah they are definitely gaps but do not want to give the false impression that private hospital insurance has anything to do with them like many think. It only covers hospital procedures so any costs incurred outside hospital in private specialist rooms only attract a Medicare rebate.

Our example of out of hospital fees:

Our pregnancy mgt fee was around $2000 (i'll check with my wife when she gets back) and attracted a small rebate, our anaesthetist was $0 for a c-section (we asked our Ob to be No Gap patients so anaethetist might have honoured this), plus cost of each consultation. We have mid range cover and used one of Brisbane's top obstetricians.

As an aside are you sure it is because you have top cover that the surgeons costs was $0? I didn't think the level of cover affected how much the surgeon got from your fund...or maybe that is just the insurance I have looked at?

Dorothy

You may want to ring the secretary in the department where you're supposed to have surgery. As someone who does bookings I can say that there are times when things get overlooked for any number of reasons - registrar forgot to give the secretary the booking slip, letter went out but you never got it so DNA'd and didn't get rescheduled, referral got lost in the post, etc.

If you call the department secretary she can look into it for you. Lots of times it's just a matter of reminding someone that you're waiting. And remember, we're really just crappy paid public servants, so be nice when you talk to her.

elice_in_oz

I agree that a public hospital birth is just as good if not better, although I would say it depends on the public hospital you go to. I was lucky to be in a brand new hospital and so had my own room and ensuite (even in the delivery suite), and my experience was very good.

OP, I can't comment on many other treatments although recently, I had a mammogram and ultrasound and I had to pay $225 out of pocket (Medicare covered about $160) and my PHI paid zilch. We only have basic extras though so not sure if the higher covers are better for these kind of things. OH has had a couple of MRIs for his knee, and again, zilch from PHI and a little refund from Medicare.

HelenTD

My son injured his knee on Friday lunchtime. The school nurse thought that it might have been dislocated, but you could see that the kneecap looked to be in the right position. She was concerned about any damage being caused if he was moved and wanted to ring for an ambulance, rather than us transporting him to the hospital or to a medical practice. The hospital took x-rays which showed that there were no fractures. I asked 2 doctors, 1 nurse and the radiographer how any joint damage would be picked up, for example would an ultrasound or scan show damage to the joint? They were very evasive. The nurse said that they wouldn't do an MRI scan on a knee, the others told us nothing. The more senior doctor told us that they wanted to give my son more painkillers, when an adult-sized dose had been given 1.5 hours before. Their reason for this was that he couldn't lift his leg because it was painful, so they wanted to give him more painkillers to see if he could lift his leg once the pain had been removed, and that this would show if any ligaments or tendons were damaged.

What would your reaction have been to this?

Dorothy

I would have said the nurse is full of crap. I injured my knee in October/November and had an MRI which showed exactly what was wrong with it. As a matter of fact, I took the films and report to the surgeon with me. Luckily for me staying off it and keeping it firmly wrapped for 6 weeks meant that I didn't need surgery after all.

Ask your GP for a referral to an orthopaedic surgeon (I'll PM you the names of some that I know) and for a referral for MRI.

moneypenny20

Second point of call for daughter with an 'iffy' knee, after the doctor was an MRI. How else are they supposed to see what's happening? Third point of call was day surgery for an arthroscopy.

HelenTD

Thanks Dorothy and MP - I wanted some reassurance that I wasn't being difficult (not that I would ever be). I don't know how the 1st doctor passed the IELTS, the 2nd doctor attempted to bully me into it and no one could understand the point I was making - analgesia wasn't going to confirm what was going on in the joint. I refused to let them give him more painkiller and wished like hell that I'd gone straight to the sports doctor who would have ordered the MRI. We left the hospital after x-rays, with a full leg splint and an appointment for the orthopaedic out-patient clinic tomorrow. I'll be spending tomorrow morning on the phone, trying to sort out some proper medical care for him, God knows what they'd try to do to him if I turn up at the hospital tomorrow (pretty sure they'd lock me up, I have a very low tolerance for medical incompetence).

Dorothy - yes, please pm me some orthopaedic names.