Health & Family Private health insurance

Excess in addition to the 75% MBS fee and up to a limit.

 

I stand by my comment on how silly private health insurance is. Ridiculously confusing.

So in my instance, for the couple of stitches I recieved from a doctor in training at the hospital. My excess is $500. Youre saying the hospital would have charged my health fund more than that and then covered the $500 themselves?

 

That's what forums like this are for- Education/Knowledge. Yes it's confusing but so are many other things in life that are worth the time and money.

If you got your procedure done in a public hospital as a public patient - (taxpayer picks up the bill). If you got it done as a private patient there may or may not be an excess - some funds have no excess for accidents, quick day procedures etc. Others will charge you an excess once per policy per year. So you have to decide if it the wait is worth the excess you are saving.

 

Yeah my policy is once per year $500. So i would have paid $500 for a couple of stitches.

Id appreciate not being called a fool for doing something every1 in my position would have done @Bran

 

@JohnPropChat thanks for taking the time to write that up, that's the clearest I've seen anyone explain it over the years. I'll re-read it again with a fresh head in the morning. Cheers.

 

The public hospital (or of the 12-15 I've worked at across two states, at least) tries to incentivise you utilising your private insurance. To do this, they ensure you are not out of pocket. If you were made out of pocket to use a public hospital, just because you had private insurance, then everyone would do as you did. If you are admitted as a private patient to a public hospital, nothing changes for you. Nothing. But the hospital gets paid by the health fund, instead of paying for your care. There are no excesses, no gaps, nothing. And I treat you no differently, and mostly I don't know. I wish I did though - I would take you privately so I could keep my waiting list down - and that is the whole point of private insurance from a health care provider/government perspective.

 

Rather than quibbling about $500, I'd be more worried about the spinal injury you may have incurred when you smashed your face in the pool sufficiently hard enough to break your nose. Did you ask whether you would be out of pocket if you had private insurance?

You say "every1", but I, for one, would say I had private insurance and let the public hospital get some extra dollars. So, not everyone. And in my public job (which is >80% of my time and employment), I bring in over 100K a year for the public hospital, paid to the public hospital. Most of us do this, which is a huge boon. Being treated as an 'intermediate' patient is different, and I have no idea nor interest on how this works.

 

Good luck
I pay someone to sort this out for me so I can focus on looking after the patient.

The other consideration is AMA recommend fee. There is a stark difference between the AMA and the MBS reimbursement. This is where medical practitioners are critical of the health providers, and why there is a gap.

The doctors that charge double AMA rates should be punished for bringing our profession into disrepute.

I've done two private emergency operations this evening, both literally life-saving. I consider these patients captive, and with no options. Thus they receive no out of pocket expense from me or my anaesthetist whatsoever. I do not consider it reasonable to have a discussion about money at this time.

Electively, I provide a quote. If the patient has concerns, they are invited to discuss it and I do what I can. Otherwise, I put them straight on my public list - but strictly at no advantage over public patients.

 

I think I'm going to stop responding to medical threads. It causes me to at least seem to adopt a stance defending one side or the other, when the opposite is often true.

Private health insurance is your choice. It's a luxury. I have it for my family, and foreseeably always will.

Medically, out

 

Yes, this is Australia we are not in USA, public system works well for us.

 

Mate im pretty sure your roaming far off topic there. Yes I smashed my face. Yes it was dumb. Did i do any spinal damage? No I didnt. Did I save myself $500 by saying i didnt have private insurance? Yes i did. Does that make private health insurance look confusing and weird? Yes it does.
End of discussion.

 

@Bran - thank you so much for your insights on this, it is extremely useful for those of us who do not have much understanding of the medical world and how it all works.

Since we discussed this in the previous thread I have tried to gain a better understanding of it all and the simple conclusion I have come to is that the best piece of mind protection I can buy is to get a Top Cover insurance with a reasonably reputable insurer. Much like what @jaybean has detailed, there might be gaps and additional costs, but the big picture item is I got the bulk of the medical expense covered. If there is a little extra cost to pay, it is no big deal in the scheme of things. Perhaps @Propagate this is your conclusion too? I too wish there was an "all in one full cover" kind of option, but Top cover seems to be the next best thing.

Thanks again @Bran and all the other helpful posters in this thread!

 

Yes thanks to @Bran, a lot clearer now in helping me to decide!

 

Junk PHI policies - If you’ve got one of the policies, you’re better off saving the cash.

PHI Report Card 2016. Very good. AMA Private Health Insurance Report Card 2016

Bottom line - Get top cover if you can afford it.

 

It's all about funding and I am afraid it's going to get worst. With budget pressures federal government will start cranking on these loopholes as well. Check this
out.....Why public hospitals want you to use your private health insurance


@Propagate I am with HCF as well on their corporate discount. One thing worth checking out with HCF or any other provider is if insurance required for adults only, consider taking two separate individual policy it might be cheaper.... I am on the lowest hospital only cover
and my partner is on highest hospital only cover. We signed up few years when these policy used to be called Budget Hospital and Top plus cover with $450 access..

 

I had health partners for 2 years never used it was about $100 per month. And was going up to $180 per month so I cancelled it.

When I called they were like " why are you cancelling???"

 

We are with HBF which is a very large (and expensive) provider in WA. We were fortunate to find two of the top neurosurgeons in WA had a no gap agreement with them and they have paid out over $100k in surgeries for MrWestminster.
Between his surgeries, dental care, glasses for 3, speechies, OT and physio for youngest we have had very good value from our health insurance.

 

I just cancelled ours, what a waste of money and has gone up from $140/month to $200/month in 2 years. I figured we are better off to set the insurance money aside and use it when we see health care, dentists, chiro etc.

 

Exactly