louie

I need an operation, pretty urgently; it's more likely than not it's cancer. We are entitled to Medicare and have private health cover, neither of which have we needed to use before.

I've just been emailed a quote by the surgeon:

Hospital: Pay Excess at Admission

Surgeon

Fees: $7567.50 Rebate (Medicare & Health Fund): $2647.10

Anaesthetist

Fees: $1300 - $1500 Rebate (Medicare & Health Fund) $550 - $650 Gap $750 - $850

Assisting Dr. : Charge approx 20% of surgeon's fees

Fees: $1513.50 Rebate (Medicare & Health Fund): $529.42

Obviously I have queried this as I am not sure I am understanding it correctly, but I think it is saying that Medicare and the health fund will only pay about one third of the cost. Can that possibly be right?

ianandhelena

Have you contacted your health fund?

louie

Not yet, I'm waiting for the surgeon to clarify whether I am reading the quote right first.

Has anyone else found that they have to pay 2/3 of the bill even when they have health insurance?

goldchoccycoin

No - I paid about ~10-15% out of pocket when I had back surgery (mostly anaesthetist fees as the medicare rebate for them is tiny).

Why are you going private? Can you get it done publicly? If it's cancer (I have my fingers crossed for you that it isn't) then it should be done quickly at a public hospital.

Best of luck.

louie

GP referred me to specialist, specialist referred me to oncologist, who I saw yesterday. Until the email arrived today I had no idea that I may be up for paying anything significant as no-one had mentioned money, other than having to pay for consultations and getting a bit back from Medicare. Maybe I should have asked, but as I say I'm new to how medicine works over here and thought having private cover would mean they paid most of the cost.

Thanks for your kind thoughts.

Kiwikaye

I'm not sure if this helps, but I had an operation last year. Not cancer thank goodness, but there were some indications. I had it through the public system (we don't have private cover), and my total out of pockets were about $400 for the consultations with the specialist, and nothing at all for the hospital stay/surgery.

It sounds to me like they are quoting you as a private patient - have you checked how long the waiting list would be if you went public? For mine, they initially said the wait could be 9-12 months and I was in and out in under 4.

spouse of scouse

Hi Louie, sorry to hear that you need surgery, it's very worrying for you.

I agree that phoning your private health insurer and giving them the details of your quote is a must. Is the surgery to be in a private hospital? The quote you've been given is for a private patient in a private or public hospital, which is why you've been told you'll need to pay the excess amount you've nominated with your private insurer.

You can request to be treated as a public patient in a public hospital (but not at a private one), even if you have private cover. The public hospital MUST accept this, it's your right as an Oz citizen/permanent resident. You would typically have no out of pocket expenses at all as a public patient in a public hospital.

The surgeon is another thing entirely. He may or may not accept you as a public patient, I'd clarify this with him as soon as possible. Most of them do operate in public hospitals as well as private ones. The amount they are reimbursed from Medicare (public) is less than they receive from a patient's private insurer.

Surgeon and anaesthetist fees vary dramatically, I've had ops in private hospitals that Medicare and my private insurer have fully covered, and have been thousands of dollars out of pocket with others. The difference is always the surgeon and anaesthetist fees.

So, your action plan is contact your private insurer, contact your surgeon, then have a cuppa or a glass of wine and try not to worry too much. Easier said than done, I know. Look after yourself x

m_j_t

The last operation that I had, when confronted with the anaesthetist I said (as it was) that the specialist told me the operation was fully covered. They dropped the anaesthetist fee straight away. I do believe that I read something that says that you must be informed of all costs or major costs before you are admitted. However, this may be state specific.

In NSW according to "Your Health Rights and Responsibilities" http://www0.health.nsw.gov.au/polici...PD2011_022.pdf

Japonica

Agree. I've had procedures in a private hospital where all I had to pay was the excess and everything else was covered, and then other instances where it was a lot higher. My son needed dental surgery in a private hospital setting and while the insurance covered this, it was the anaesthesiologist fees that added to the bill. From memory, it was about $900 and only a fraction was covered. Plus we had to pay about $2k to the dentist as well.

To the OP, lots of good advice in the other posts. Good luck! I hope you get some answers soon and try not to worry.

Swerv-o

+1 to this.

The quotation you have been offered is to be seen as a private patient in either a private or public hospital. Only you can know how urgent this is, and whether there is any scope for waiting for a slot at a public hospital.

Your PHI will pick up some of the costs from this, but by no means all - you will inevitably be out of pocket to some extent, which is known as 'The gap'. PHI usually pays a % of the Medicare schedule amount, and will depend on your level of cover and the policy you have, but it is entirely possible that PHI and Medicare will only cover the values you have been quoted. You need to check your policy first however.

Good luck with it all - and I hope that the prognosis is better than you fear.


S

moneypenny20

I'd go back to the Oncologist, determine how urgent he/she thinks it is and ask about going though the public system as you've obviously been quoted for going private. The husband has had awesome and quick Cancer treatment through the public system, I can't see why, unless the lists are crazy long, that you need private for something like Cancer. All the best to you whatever, hope you are fit and well again as soon as possible.

jad n rich

Louie, it depends on the cover and the specialist.

For the same op with Bupa, I was quoted no out of pocket fee with my lovely scottish surgeon, and a lady surgeon wanted around 2800 out of pocket fees.

That was just for her fee. her explanation was if I was with another fund I would have got a bigger rebate. Amazing as the other surgeon could do it with not gap !!

I released early on its about negotiating and shopping around. Yes that is a hideous situation if you need urgent care.

Now with specialists, even with Private health the health fund only pays for their bit IN hospital, and usually one post checkup, the initial and other visits, the only rebate is the medicare thing, for eg, my specialist charges $450 for a first visit !! medicare pays around 140 from memory, then a check up is $150 for a short consultation and medicare paid about $68 last time. Medicare rebates are on a schedule fee, and specialists charge way way above the schedule fee.

My health fund gives a list or you can online search, specialists, hospitals which they have financial agreements with and so usually you end up way better off, or no gap.

As for getting things done on medicare, really look into it.

I had boob trouble recently and spent over $1000 out of pocket on various scans and biopsy and my GP's analysis of it all was she really could not say!!! The report from the womens imaging place found concern in the other breast and did a biopsy on that, ignoring the trouble one, Breast screen qld would not deal with it as it was not found at my 2 yearly check up. So back in Victoria I asked GP for referal to a breast clinic at the hospital, that was October and still have not even had a letter for an appointment!!!!

So now I am getting another private opinion which will be another $1000 + probably and its out of hopsital so Bupa wont cover it and medicare rebates are tiny compared to the fee.

Get down to your health fund and make them search up the specialists etc you need and if you are going on medicare, for heavens sake do all you can to find out how long you are likely to wait.

We have a medium hospital cover and a high extras policy.

Fardell

Australia has a problem with medical and health costs and a lot of it comes back to specialist and particularly surgical costs - where procedural costs can rival the US! (Some) surgeons are overcharging significantly - there is very little pricing transparency -and anaesthetists are routinely the best paid occupation in Australia.

The private health funds have just woken up to the fact that routinely passing on fees will lead to their demise and the push back is starting. Part of the problem is the "cosy" collegiate working relationship between GP's, specialists and surgeons where cost is rarely a factor - seniority, connections and professional gravitas are. Everyone should make clear to the GP that costs are a consideration in the process and alternatives must be provided - so that you can ask for separate quotes.

It sounds "tawdry" - who feels comfortable talking money in these situations - but what choice is there - medicine has ceased being a vocation for many surgeons, it is a business where they have a lot of price leverage, and many use it. Also, price and quality do not necessarily equate.

spouse of scouse

I agree with some of your comments but if we're going to talk about problems with the cost of medical care in Australia, then access for all to hospital/surgical care through Medicare needs to form part of the discussion.

Not on this thread though, not the place in my opinion.

Louie, I hope you had some success with your enquiries and have a surgery date. Best wishes.

Fardell

I understand your response, I wasn't being specific enough. What I was trying to say, rather poorly, is that I would go back to the GP for advice about how best to manage the situation - I think that they generally have a good understanding of the system and asympathetic ear.