Insurer won't pay, pls help me......

First topic message reminder :

Hi guys an gals

I wish I found this site months ago, I might have saved alot of time and money!

I have been over weight for 70% of my life, having taken all sorts of wonder drugs and just plain no eating till I whent the other way. So here I am just about to have my 30 bday and I thought enough is enough, I have to do something?

So any way to cut a long story short I have had all my test and were semi booked to operate on the 7/12, I say semi booked as my insurer has come back and said they will only pay 500 towards the op and I have to pay the rest..... Well i was stumped!!!

Apparently they have changed a few policies and I have to spend an extra $18 a month (wow) to be covered? So that's great but I have to wait 12 months..... Mmm I can't do it!

So I'm looking at financing it myself the full 14k.

Can anyone tell me if they have done this and was it worth it or are there other pitfalls I havnt seen yet?

I also noticed a few of you have had the surgery at freo hospital?? Is this possible??? I'm booked into the mount with Mr Allan Thomas. Here in Perth

I'm sure it would be cheaper at freo? Lol.

Again I wish I had of seen this forum before it would have helped alot, but anyways thanks for your time reading my post.

Peace out


RR

wow! mine was only $900 - i paid $450 from that

I have HIF goldstarter hospital which is the lowest cover available and I was able to get my sleeve covered through PHI (well hospital and theatre etc)

Mine cost $1300, but I was under an extra hour to fix my hiatus hernia.
I paid $550 of this, Medicare and my PHI covered the rest.

I have a quote for my plastic surgery next month, $1700 and thats for 3 hours.

Hope this helps.

RROSSI wrote:

Does any one know what the Anaethatist will charge?? or have any ideas?

If its over 2k Im gonna have to wait a year as I will be stretched......to the max


RR

they are all different mine cost $2000, but im also told it depends on how long your under as well.
keep in mind if you use super they tax heavily, and if your on any kind of centrelink payments what ever super you get out is classed as an income.
I got a loan to get my surgery.... and it has been the best thing i have ever done.
good luck.

They seem to vary a bit RRossi, so probably best to check with your own team on Monday. But mine was well inside that figure.

Cheers - Carrie

Does any one know what the Anaethatist will charge?? or have any ideas?

If its over 2k Im gonna have to wait a year as I will be stretched......to the max


RR

I have bugeted around the 1600 for the Anaethatis as that is what my brother paid when he had his lap-band? I have called them up and they cant give me a price till monday and just conveniatly I will have to wait till then so they will try and squeeze a bit more cash from me!!

They said it will be a higher cost because im not insured??? wtf??? anyway does anyone know what I might be up for??

any thoughts??

RR

if anything goes wrong in surgery you should be covered it is NOT a pre existing condition. that means your normal fees surgery and accomidation will not be covered but extra days an icu and return to surgery will be covered. you may have to argue the point but if your current coverage covers you and you are just doing your 12 month wait you will be covered.

best insurance policy out there.

can I suggest you phone other health insurance mobs and ask if a transfer to them at your old level would cover you for the sleeve. not all health insurance mobs have raised their levels yet. with a lot of phone calls you might get a transfer and covered. if it was my money I would phone every one out there.

applesauce

Hi there

I found I had to up my health insurance too, which was annoying after years of paying a not inconsiderable monthly premium. Now have highest level of cover with AHM and am just waiting for the 12 months to pass ... will be up mid May 2011.

I thought of accessing superannuation but it struck me as a much more expensive way of paying for it... not that super funds have exactly hit i big in terms of investment returns in recent years. In the end I figured that it was easiest to just bide my time and wait the 12 months out. We've just bought a house so forking out the full amount for the op was a bit out of the question.

Good luck with your choice. I'll be here surfing and killing time by reading up on everyone else's experiences:)

Jigglypuff wrote:

Hi RROSSI,

I have Mr Thomas doing my surgery in a couple of weeks at SJOG Murdoch. The out of pocket cost from him is around $4200 plus the gas man. Just thought you might like to know his costs as they do vary a lot between surgeons.

He is an easy Dr to talk to about concerns and happy to answer the many questions you may have. Wishing you every success with your Insurance and future op.

Yay for thin and poor....hehe

Jiggly x

Yeah he's doing mine as well but at the Mount, and yeah he is a nice guy, so cant complain there, but to be honest I dont really care who cuts me up, there all good Surgeon's.

RR

Hi RROSSI,

I have Mr Thomas doing my surgery in a couple of weeks at SJOG Murdoch. The out of pocket cost from him is around $4200 plus the gas man. Just thought you might like to know his costs as they do vary a lot between surgeons.

He is an easy Dr to talk to about concerns and happy to answer the many questions you may have. Wishing you every success with your Insurance and future op.

Yay for thin and poor....hehe

Jiggly x

Sapphire wrote:

Hi!

It's quite "normal" to be out of pocket $4-$5K with PHI!
My surgery alone will cost $4800 and Medicare/PHI combined will cover just over $800 of that. Anaesthetist on top of this. Thankfully PHI covers theatre costs and hospital accommodation/meals. It's expensive, but from what everyone on here is saying - well worth it.

Good luck!

yeah 4-5k is a walk in the park, 14k is a bit tough to swallow pardon the pun,

but meh it has to be done so 34 days and counting, I will be thin and poor at the same time?? lol

RR

Hi!

It's quite "normal" to be out of pocket $4-$5K with PHI!
My surgery alone will cost $4800 and Medicare/PHI combined will cover just over $800 of that. Anaesthetist on top of this. Thankfully PHI covers theatre costs and hospital accommodation/meals. It's expensive, but from what everyone on here is saying - well worth it.

Good luck!

comet wrote:

Hi RRossi, that sounds like bad news, can I ask which fund it was and which cover you have?

I have a MBF choices cover plan, it has been upped as of yesterday, question I need to ask them is say the sleeve leaks a month down the track, would I be covered? then?

If anyone else knows feel free to let me know.

cheers

RR

Hi RRossi, that sounds like bad news, can I ask which fund it was and which cover you have?

Hi RRossi,

I self-funded by cashing in some of my superannuation. This is possible because obesity is considered a life threatening illness. If you call your surgeon straight away, they should be able to provide the information you need to get approval for that. The applications can be downloaded from the APRA site.

Here's a link to the APRA site:
http://www.apra.gov.au/superannuation/early-release-of-superannuation-benefits.cfm

Here's the information brochure:
http://www.apra.gov.au/Superannuation/upload/APRA-ROB-Brochure-v5-15-Dec-2008.pdf

Here's the guidelines for your Dr:
http://www.apra.gov.au/Superannuation/upload/SA_ROB_MED_032009_temp.pdf

Here's the form you need:
http://www.apra.gov.au/Superannuation/upload/APRA-ROB-Form-Medical-or-dental-23-Dec-2008.pdf

I hope that helps.

Cheers - Carrie

Most Kiwis are full self pay. Costs for WLS in NZ vary from about $18000-$30000. The max insurance input here is $5000-$7500 if you are lucky.

At the end of the day only you can decide. For me it was the best thing I ever did for myself.

If you cannot afford to pay then hunt for the best deal you can if you can do it then you will most likely never look back.

You can't get done at freo unfortunately some have tried to gain funds through apra to access their super... All the best and you will love the sleeve....also look at the get togethers we are having one on the 20th November..
Take care...

Hi guys an gals

I wish I found this site months ago, I might have saved alot of time and money!

I have been over weight for 70% of my life, having taken all sorts of wonder drugs and just plain no eating till I whent the other way. So here I am just about to have my 30 bday and I thought enough is enough, I have to do something?

So any way to cut a long story short I have had all my test and were semi booked to operate on the 7/12, I say semi booked as my insurer has come back and said they will only pay 500 towards the op and I have to pay the rest..... Well i was stumped!!!

Apparently they have changed a few policies and I have to spend an extra $18 a month (wow) to be covered? So that's great but I have to wait 12 months..... Mmm I can't do it!

So I'm looking at financing it myself the full 14k.

Can anyone tell me if they have done this and was it worth it or are there other pitfalls I havnt seen yet?

I also noticed a few of you have had the surgery at freo hospital?? Is this possible??? I'm booked into the mount with Mr Allan Thomas. Here in Perth

I'm sure it would be cheaper at freo? Lol.

Again I wish I had of seen this forum before it would have helped alot, but anyways thanks for your time reading my post.

Peace out


RR