Originally Posted by scrudu (Post 10701293)

Can someone please explain because I am now quite confused as to why we paid for private health insurance at all. We arrived 2 years ago and got private health insurance before the end of our first year for 3 reasons:

1. So that we'd have private health cover to assist with hospital fees
2. So that we wouldn't be penalised with the LHC loading if we decided to join later
3. So that we wouldn't be penalised by paying the Medicare levy surcharge at the EOFY

We've passed the 1 year point for pre-existing conditions, and I've been recommended by a hand surgeon to have surgery for a problem wrist. From what the secretary told me, the fees will work out as follows:

• Surgeon + Asst Surgeon Fees
  • Surgeons Fee: $2679
  • Rebate: $1005 (Medicare=$754 + Fund=$251)
  • Out of Pocket: $1674
• Anaesthetic Fees (approx.)
  • Anaesthetist Fee: $1200
  • Rebate: $467 (Medicare=$350 + Fund=$117)
  • Out of Pocket: $733
• Hospital Fees: Covered by Fund (?? Are these fees exorbitant?)
• Total out of Pocket: $2407
• Total paid by Health fund: $367 + Hospital fees (unknown)
• Up front payment (as per healthfund rules): $250

This is the first time I've needed to use the priv health insurance and I'm confused by how little the insurance fund seem to contribute. On similar private health insurance in Ireland, I'd have to pay an excess (e.g. EUR100), but all other fees (surgeon, hospital, anaesthetic fees) would be paid by the health fund, so I'm stunned to think I'll have a bill for $2400 despite having "family level" hospital cover which wasn't cheap. The receptionist explained that the healthfund only pay 25% of a Medicare scheduled fee for procedures. and Medicare the rest.

I'm trying to figure out for next year if we'd be better off simply cutting out our health insurance policy and saving the money towards such unexpected surgeries? Obviously in this situation I am better off going to the private hospital as apparently I'd wait 2-3 years in the public system, but if the fund is only paying 25% of a scheduled fee (in total $367) that has no bearing on the AMA designated fee I have to pay, it seems financially we'd have been HEAPS off this year not to pay for PHI, and to have paid outright for the private surgery. Am I missing something? Perhaps the hospital fees for the private hospital are significant? Or is it just simply a rort and we should pay the Medicare surcharge and pay outright for private care when needed?

Originally Posted by scrudu (Post 10701415)

Cheers for the advice folks.

I completely understand going for private treatment vs public treatment, but what's confusing me is as to why you'd pay private health insurance to do this rather than simply pay for the private care. If my calculations for my planned surgery are correct, if the healthfund were out of the picture, I'd only have to pay an extra 25% of the scheduled MBS fee which is all they are paying, so in total $368. I have no idea what the part day fee is for the time I will spend in hospital, but I'd have to pay that also. From what other posters have said, if I wasn't privately insured, I'd possibly get reduced rates from both the Anaesthetist & Surgeon which would reduce those figures.
Given that we've paid near $3000 for 2 adults insurance, and this is the first time we've used it, I can't figure out how financially it makes sense.

Originally Posted by jad n rich (Post 10701434)

Does that include extras?

A dental check up and clean $186. The kids up that free. we get back 80%. So we claim back $1336 of the premium on dental check ups alone. (2A2K twice yearly) Plus 2 of us have glasses, we get $250 back each. So nearly 2k of pemium comes back.

If your not going to get screwed for extra tax by giving it up, then saving it could be an option. Maybe price up a few things that might go wrong, and see how many years it might take to cover.

Originally Posted by scrudu (Post 10701447)

Yeah that includes Extras (basic) with AHM. We haven't got much benefit out of the extras so I reckon we'll drop that next year. So far I got $17 off a physio appt ($70 fee), same for an acupuncture appt, and for dental, a checkup and clean cost approx $250 each, and the fund paid about $120 so quite out of pocket. From the figures you've given I can see how it'd make sense for you to pay for Extras, but you can buy that without Hospital cover right?

Good idea about looking at this over a number of years. It's hard to do the calculations without knowing the figures though. I know I'll need a stapedectomy (middle ear surgery) soon, and am dreading how much out of pocket I'll be for that. All in all it'd put you off having surgery at all :(

Originally Posted by ozzieeagle (Post 10701468)

If you have a new life threating condition that needs plenty of tests and no queue waiting then private health insurance is vital.

Originally Posted by Buzzy--Bee (Post 10701470)

And that's why we have it. Major emergencies only, when you don't care what the cost is, you just want to get better and not to die.

Friends parents gave up their private health in their 70s and the year after had to find $40,000 for major heart surgery. Luckily they had the money.

BB

Originally Posted by BadgeIsBack (Post 10701518)

..but how to weigh all this up with a known or uncertain probability?
I can understand waiting for surgury - but how likely are you to get a life threatening condition which also involves a long wait which is then likely to kill you?