scrudu

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?

spuddyo

The answer is, based on my experience, yes. We have been here 18 years and never paid any health insurance, but do pay the extra Medicare Levies because of this. We must have spent $20,000 less than if we had full family insurance. It's a gamble like all insurance, but for us it has been a wise decision so far. During that time we have had various reasons to seek medical attention in hospital, but it has all been taken care of by Medicare. On one occassion we needed and ambulance, and didn't even get charged for that. the first thing they ask at hospital is 'do you have private health insurance' from that point on your answer seems to make a huge difference.

jad n rich

2/3 years wait on medicare with a injured wrist, party why people have it. Medicare is broke. Imagine if instead of a broken wrist it was life threatening. The wait on medicare can make a massive difference to the outcome in that situation.

However yes its a rip off, welcome to australia

Price surgery around, seriously. I have found with Bupa a no gap surgeon, and one that with gaps will be almost $1600. Both very well respected surgeons and identical surgery/hosp. Some have agreements with funds hence the difference.

My recent broken leg accident means I spent best part of a week in a public hospital via ambulance/ER.

5 days confined to a public hospital bed before they could do the surgery required. The system is stretched beyond belief. All I can say is I wont be giving up private after that experience.

Plus if you earn a decent income and dont have private the govt will screw you again anyway.

Amazulu

It's not compulsory. Personally we've taken out more than we've put in to medical insurance.

Medicare, like the NHS, generally works well. Any public health system that is free at point of use is going to be strained in certain areas - it's inevitable

scrudu

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.

jad n rich

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.

scrudu

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

jad n rich

I pay $12 out of pocket with bupa for a $60 physio appointment.

I find it increasingly frustrating that every time we have a health issue there is a mass of time spent on pricing it up. It is bloody crazy, we pay medicare, private health and still have gaps to pay.

Good luck with it all.

ozzieeagle

If you have a new life threating condition that needs plenty of tests and no queue waiting then private health insurance is vital. Despite it's failings, at our age in our 50's and despite the definite exorbitant costs and lack of refunds, I daren't go without it. Just in case one of us develops a condition where it's necessary.... Things like hip replacements etc 100 pct vital.... there is something like a 18 month wait for those on the public system.

Murphys law dictates that If I gave up our 280 buck per month family payment to HCF, one of us would develop a condition which would necessitate using private, which thankfully uptil now we have been totally free of.

Pays for peace of mind in our household, it's one cost I really wish we didnt have but feel we have to. It's basically a guaranteed queue jumping mechanism.

Buzzy--Bee

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

jimbo_d

Depends which provider and which state as to what you'll get out. Pay more in, get more out. There are certain private insurers that you should not touch with a barge poll (one well known one located in the UK rings a bell) that are renowned for not paying out what you think they should. Certain insurers are state based and therefore pay more to state based services, HBF in WA for example. Look on choice for the best providers, ignore Iselect etc as they only feature providers who pay them to feature them.

JoeBloggs80

Getting only 25% back seems low. I'm with NIB and get 70% back on everything (up ot the threshold).

I've taken out way more than we've put in on dental/opticians/physio the last couple of years

BadgeIsBack

I don't have private but one day we might do it. Yes I will cough up more.

To be quite honest, I/ we don't consider health that much. Now I think about it, it might even be that noone in my family ever seems to get conditions..(I know I know). They get to their 90s then die. Noone has ever been hospitalised for anything that I can ever recall. Hearts, joints just go on.

If I was used to hearing about day to day problematic conditions from family members and/or knew I was likely to get a,b or c (because it ran in the family) then to be honest it would have been a different decision a while back. It might sound daft, but we just don't seem to patronise doctors and hospitals, apart from trauma, naturally.

I am getting to the point where I have to make a choice - what is likely to go wrong and will private help?

I had a heart check up which involved a battery of tests last year and the consultant at Monash basically told me that I had just broken the record (for my age I suspect) and basically told me to eff off and not come back...(I'm quite serious - please do not lay in to me!) The technicians were exchanging glances during the latter phases and one suggested they thought I was better off in London...

..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?

Swerv-o

Me too. I keep it for life threatening emergencies only. I have trimmed away all of the worthless Extras cover, and now just have Hospital and Ambulance. I've also trimmed off the stuff that doesn't concern me like reproductive assistance etc.

even though I wear glasses, I found that I was never getting ahead with the Extras cover - particularly as the cover was only redeemable at Australian based opticians, and couldn't be used for online purchases.

The gap payments are astronomical - and even with insurance you can still be left with significant out of pocket costs. It would be nice if you could buy a top up policy to cover the gap payments, like they offer in France, but that would require a bit of forward thinking.

Personally, i think the entire system is a bloody mess, is over complex, and offers appalling value for money when compared to health insurance policies in other jurisdictions. However they virtually make you have it to avoid the additional taxation that comes with not having it.

Personally, I have had to have quite a few hospital visits since I arrived here - up to number 7 now, all requiring surgery under general aneasthetic. So far I have not touched my PHI - I have always opted for the public system, and have never had to wait longer than 2 weeks for an admission. However NONE of this has been life threatening, and I can't comment on waiting times for other procedures.


S

ozzieeagle

Most likely candidate for that is heart valve replacements. Doesnt happen in my family either.... seems to in the wifes though. Hopefully we'll both stay clear

Your lucky if both of you dont have family history of anything.... Prostate runs on my side, never kills anyone though.