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When to use private hospital cover?

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Old Dec 3rd 2017, 7:23 am
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Question When to use private hospital cover?

Hi all,

I have basic hospital cover but on a recent trip to the emergency room, didn't know if I should declare it. I went there with a suspected heart complaint (was a false alarm thankfully) and had an ECG, bloods and chest x-ray. My basic cover doesn't include heart-related tests.

I said I didn't have cover because I knew I wasn't covered for these tests and also because my excess is $500 and I am broke, but was that the right decision? My trip was covered by Medicare and I paid nothing.

What would have happened if I had said "yes" about having insurance? Should I always declare it, even if my tests/treatment are not covered? Was I being unethical by saying "no" or do I have the right to choose whether or not to use my insurance?

Still a rather grey area for me.

Thank you!
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Old Dec 3rd 2017, 12:47 pm
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Default Re: When to use private hospital cover?

Originally Posted by red7 View Post
Hi all,

I have basic hospital cover but on a recent trip to the emergency room, didn't know if I should declare it. I went there with a suspected heart complaint (was a false alarm thankfully) and had an ECG, bloods and chest x-ray. My basic cover doesn't include heart-related tests.

I said I didn't have cover because I knew I wasn't covered for these tests and also because my excess is $500 and I am broke, but was that the right decision? My trip was covered by Medicare and I paid nothing.

What would have happened if I had said "yes" about having insurance? Should I always declare it, even if my tests/treatment are not covered? Was I being unethical by saying "no" or do I have the right to choose whether or not to use my insurance?

Still a rather grey area for me.

Thank you!
Hi Red. You don't have to disclose that you have private health cover if you attend a public hospital. You pay for Medicare through your taxes so it's not as though you're getting something for nothing. You did nothing wrong.

Glad that all your tests were ok.
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Old Dec 3rd 2017, 9:08 pm
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Default Re: When to use private hospital cover?

Originally Posted by red7 View Post
Hi all,

I have basic hospital cover but on a recent trip to the emergency room, didn't know if I should declare it. I went there with a suspected heart complaint (was a false alarm thankfully) and had an ECG, bloods and chest x-ray. My basic cover doesn't include heart-related tests.

I said I didn't have cover because I knew I wasn't covered for these tests and also because my excess is $500 and I am broke, but was that the right decision? My trip was covered by Medicare and I paid nothing.

What would have happened if I had said "yes" about having insurance? Should I always declare it, even if my tests/treatment are not covered? Was I being unethical by saying "no" or do I have the right to choose whether or not to use my insurance?

Still a rather grey area for me.

Thank you!

Completely agree with SoS above. You have done nothing wrong in not declaring you health insurance. As you presented to an emergency department, and it was not an elective or planned visit, and that you say you are broke, you would have ended up paying a lot more than the excess on the policy.

It is always up to the consumer if they choose to use their insurance or not - you need to look at your circumstances carefully, and decide if it is worth it. I have had a lot of surgery since I have been in Australia, and have never used my insurance for it, as I was happy with the wait time and access to the system for the issues I had.


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Old Dec 3rd 2017, 11:44 pm
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Default Re: When to use private hospital cover?

Thank you both so much for this info. Yes, I am employed and therefore pay taxes, so it's good to know that I'm paying for it myself. Thanks for the easy explanation, I will likely refer to it often!
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Old Dec 4th 2017, 1:59 am
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Default Re: When to use private hospital cover?

Originally Posted by red7 View Post
Thank you both so much for this info. Yes, I am employed and therefore pay taxes, so it's good to know that I'm paying for it myself. Thanks for the easy explanation, I will likely refer to it often!
I am unsure what state you are in, but I don't know why one wouldn't admit of having heath insurance- especially their seems to be a subtle disdain for those wihtout private insurance.
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Old Dec 4th 2017, 3:19 am
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Default Re: When to use private hospital cover?

Originally Posted by morpeth View Post
I am unsure what state you are in, but I don't know why one wouldn't admit of having heath insurance- especially their seems to be a subtle disdain for those wihtout private insurance.
I think it's because, like swerv-o said, I would have ended up paying over $500 if I had declare my health insurance. As I did not declare it, my visit was covered my Medicare. I'm in QLD.
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Old Dec 4th 2017, 10:29 am
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Default Re: When to use private hospital cover?

In WA if you have private insurance and choose a public hospital you are not charged any excess. If you are admitted to hospital you will be allocated a private room if there's one available, you will have your preferred consultant (if he/she is available) and you will be helping the hospital keep their costs down, as private pays the hospital a higher rate than Medicare for the same service. No charge for you.
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Old Dec 4th 2017, 11:57 pm
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Default Re: When to use private hospital cover?

Originally Posted by Dorothy View Post
In WA if you have private insurance and choose a public hospital you are not charged any excess. If you are admitted to hospital you will be allocated a private room if there's one available, you will have your preferred consultant (if he/she is available) and you will be helping the hospital keep their costs down, as private pays the hospital a higher rate than Medicare for the same service. No charge for you.
Thanks Dorothy! But now I'm confused on which is correct for QLD?! Maybe I'll ask my private cover provider.
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Old Dec 5th 2017, 1:33 am
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Default Re: When to use private hospital cover?

If you are paying Medicare fees, you are covered by Medicare for Emergencies - so you are entitled to use it. If you pay the extra Medicare Levy too, even more so. Good onya.
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Old Dec 5th 2017, 4:08 am
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Default Re: When to use private hospital cover?

In QLD I was admitted to public hospital for broken leg. Emergency obviously.

Said I was using Medicare.

They set my leg temporarily and in the 6 day wait till the full surgery I was visited daily by a admin lady asking me to authorise them to use my private cover and in return they would do it no gap fees. Leaflet about how it would benefit everyone....

I gave in on day 5 of not making it to the top of the days surgery list, gave them my private details and no gap.

The next day I got surgery, ( every other day I was not high enough a priority on the list so would fast till they announced around 6pm I had not made it.

Never got a gap payment, and the fasting was a great weight loss plan, came out feeling light as a feather )

I never got a private room, but was in a ward of 2, me and a English gentleman, most of the other rooms were 6 or 8. Think the room allocation was chance as I was in that room on medicare anyway.
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Old Mar 19th 2018, 12:32 pm
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Default Re: When to use private hospital cover?

Ha. If they find out they will confiscate your kidney.
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Old Mar 19th 2018, 1:16 pm
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Default Re: When to use private hospital cover?

If you go to Emergency you go as a Medicare patient. If something turns up in tests etc and treatment/surgery needs doing and you'll get seen quicker by using your private cover then use your Insurance. If the treatment required is simple and there's no need to use your insurance then stick with Medicare. There's no right or wrong, you do what you want with what you have. That's country wide, not state specific.
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Old Mar 20th 2018, 3:42 am
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Default Re: When to use private hospital cover?

Originally Posted by commonwealth View Post
Ha. If they find out they will confiscate your kidney.
welcome back online!
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Old Mar 20th 2018, 11:51 am
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Default Re: When to use private hospital cover?

Private cover and hospital cover is basically all about queue jumping and that's about it.

However that is quite an important advantage, especially when it comes to certain procedures and Cancer scares etc. It can mean an 18 month or more difference for things like hip and knee replacements.
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Old Mar 22nd 2018, 7:20 pm
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Default Re: When to use private hospital cover?

Originally Posted by Pollyana View Post
welcome back online!
I’m here to sell my kidney. Any takers?
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