NIB Private insurance will not fund the lap band or the VSG any more!

I was chatting to a lady last night at a party who was considering the sleeve. Last month she received a letter from NIB PHI that said that they would 'honor commitments to lap band or VSG surgery that was already booked in', but any one else, no more!

She has been a member for over 30 years, and cannot get the surgery she needs now!

Did any one else receive this letter?

It makes me wonder if NIB can do this, what about other funds? Is the surgery becoming too popular and expensive? I have been a member of Medibank Private for years, but perhaps the onslaught of people joining health funds just to qualify for this surgery is beginning to snowball and is becoming difficult for Health funds to maintain?

The Government needs to step in and make this fully covered by Medicare. Imagine how much money it would save in the long run! Australia is facing an obesity epidemic!

What do others think?

No GR, I haven't heard any of such; though I had read somewhere that Medicare was looking at funding (to a greater degree) the Lapband and Sleeve op; at least, for Medical reasons. I thought it would take effect from this last January, but obviously it hasn't gone through legal channels as yet; if it is ever put into place. One would think that anything that improves the quality of life; and decreases and/or eliminates the need of medicines and doctors and etc etc; that the government would be sure to encourage these procedures; which in turn would reduce sickness benefits, medicines purchased, doctors utilised, nursing homes in the long term.

i can't see NIB surviving to be honest simply because you can move from one health fund to another without serving waiting periods.

So, basically anyone with NIB who wants the surgery just has to change health funds..it's that simple.

However, i do agree in part with what NIB is doing. Premiums keep going up and up and alot of people joing health funds for a specific reason, such as weight loss surgery, pay their premiums for a year (average is about $1000 for a single person) have a $15000+ procedure and then cancel their health insurance.

I think thats a practice that needs to be looked at seriously as the bill ends up being picked up by people who have had private health insurance for many years and all they get is incresed premiums.

Maybe an annual percentage claim for new persons who join instead of full benefits after 12 months or waiting period of 2 years like some other procedures.

I definately agree that weight loss surgery should be funded to a much greater degree by the govt. Obesity is a major health and social issue. Look at all the ads the govt pays for to educate people about healthier eating eg, the current 'swap it' campaign. So theres this perception that the govt are serious about obesity - but why then are the waiting lists so incredibly long for people seeking help???
The Royal Adelaide Hospital Obesity Clinic only runs one morning per week!!!!! Once my GP had referred me to the clinic, it took 14 months before I could even see a Dr for my initial apt! Then I was told it could be two years or more before I could have surgery, that is, if I even qualified! So a 3 year process. Which is why the smarter option, was for me to join PHI, wait 12 months, then have the surgery. And no wonder so many more people are doing this!!!
Its time the govt stepped up its funding for obesity.
Its an issue I'm passionate about.

My premiums just went up, and NOT because I claimed, I have adult children on my premium, and we have family membership. We cannot afford to be without it! I use it mostly for dental and optical, and I joined after the amnesty, so I have the 30 percent loading for another three years. All in all, it is RATHER expensive!

If my premiums are going up to pay for the '12 month fly in fly outs' I will be VERY cross! It is HARD to pay this every month, and getting harder! I may have to go down to basic cover as the one I am on now is financially crippling me on one wage. However, I think that it is important to keep paying...I have kids who are sporty, what if they need knee surgery or what ever?

Just checked! and apparently I have always been on BASIC hospital cover, with blue ribbon extras.

I think the Government could have saved money on the 'swap' campaign (Isn't THAT a joke!...Swap a LARGE coke for a medium at Macca's!! How ridiculous!) and spent more on funding procedures for weight loss, or gym memberships etc. It's no use saddling the horse after its bolted!

The Healthy canteen campaign seems to have made inroads in schools...but one High school in my region has a Macca's next door, and a healthy canteen. The kids at that school spend their lunch money...Guess where? They sneak off campus to do it.

I have top hospital NIB and haven't received any letters like your friend. Last time someone asked about this I had just spoken with NIB specifically about the sleeve medicare item number and they didn't mention anything. I think I'll ring up after the long weekend to be sure. This could sure be a pain (but I've already booked my date thankfully).

Could be that they are changing items on lower levels of cover to make VSG top cover only?

I had heard that private health insurers weren't going to cover it anymore. Last year alone 11,000 Australians got the lap band, and I don't know how many got sleeved. obviously health funds see the large numbers and don't want to pay for something that the government should!

I am with NIB top cover and havent received a letter either. Maybe it is for the older policies that cover it under medium or a basic level of cover?
Either that or the letters are coming out really slowly.

You have already had the surgery, Shrinking Peach, so maybe you didn't get a letter?

She said she was in Top Cover. Had been for years.

Hi everyone.

I rang NIB this morning (their phones were playing up yesterday). I have top hospital cover with them, and have been a member for a number of years. The lovely bloke I spoke with said that NIB had no restrictions on my cover, that is I can have the sleeve and there was no plan to change this. The only things which are excluded are cosmetic procedures.

He did say that some changes were coming on first of june, but did not apply to me as I have top hospital cover. So there may be some truth to what people have been hearing, but my understanding is that if you have top hospital that things are fine.

Agree - I had my sleeve with NIB last year and they did tell me they were changing so that only top covers included bariatric surgery. My sister has NIB top cover and is covered for the sleeve, she's just starting the process.

hey hi ...Gottarhyme ....... OMG blow me out .............. ... I am with NIB and have been waiting since Nov 10 ...... i haven't recieved any letters about this issue ....... But i will be ringing tomorrow .... I am on the highest single Top Cover and paying $38 a week ........... i better check ...... God willing and praying it will be fine .......But thanks for the information .......

Lovely, if you have top cover you are fine. Don't get worried or stressed out. If you read my post above, I rang and confirmed there is no problem if you are in top cover. But, do call if it will ease your mind, I know I needed to.

I have top health cover, and I believe that NIB removed sleeving just after I had my op.

I've yet to see any evidence that they have removed sleeving from top cover.

ETA: I rang NIB today and gave them the item number (again). The sleeve IS covered under top hospital (and some other levels of cover actually).

It is patently FALSE to say that NIB don't cover the sleeve. It's really stressed me out to keep hearing this myth being perpetuated, so I have double checked the status of the surgery with NIB.

Really??? that is not cool

I think after 30 years with PHI, it should be honoured.
I believe there are alot of people out there joining PHI to get a procedure or two done and then are dropping the cover. I can understand why the PHI are cutting back on things. In the long run, it is the long term clients that pay for all these 'short term' patients that claim tens of thousands of dollars worth of surgery and are members for two years or so (paying about 5K in premiums).

I would be pissed if my fund turned around and said they were not paying for my surgery. I have had PHI for 36 of my 36 years and have only claimed 1 child, 2 ankle ops and chiro and dental. I am blessed to have healthy children and healthy husband. Besides me being fat, I am otherwise healthy ATM.

This is just my opinion

I had NIB as my insurer when i had my lapband done almost 3 years ago and then they dropped it from our cover. Then i starting having complications so i have actually had to go and change providers so that i can have the band removed and a sleeve done

Well, again NIB covered my sleeve July 2010.

I know someone who just got an August 2011 sleeve date and she is covered by NIB.

As always, check your own coverage details with NIB before you plan surgery.

Some people said this is no longer true. - I also got the letter in March - but it's possible VSG is back in the policy!

I have Top Cover with NIB and I was covered for my sleeve on 20 July 2011. I only booked my surgery a month beforehand and I was worried that NIB didn't cover the sleeve anymore, however when I spoke to the call centre they told me that the only surgery that NIB won't cover is cosmetic surgery, they'll cover everything else (on top cover of course!)

For the record, I was not perpetuating 'rumours' This was told to me in good faith by an NIB customer who had received the letter from them, saying that the gastric sleeve would no longer be covered under her policy.I asked her what cover she had, and she said that she and her husband had been in top cover for over 20 years.

I reported what she told me in good faith, for the information of members with that insurance. I am glad that those people with TOP cover are covered.

I have BASIC hospital with Medibank Private, and I was fully covered. Other health funds also cover the sleeve with BASIC hospital only.

I am glad that people called their funds and clarified what they were covered for.

Although, I think shopping around is also a wise thing to do, especially as some funds are happy to transfer you with no waiting periods at present.

I'm with nib and they r covering my gastric band surgery if I choose to have it done. I rang them with the same question before I had my lap band removed. They told me other health funds won't cover the surgery but they still do

HCF covered mine 6 months ago, I think NIB are telling you porkies

gottarhyme wrote:

I was chatting to a lady last night at a party who was considering the sleeve. Last month she received a letter from NIB PHI that said that they would 'honor commitments to lap band or VSG surgery that was already booked in', but any one else, no more!

She has been a member for over 30 years, and cannot get the surgery she needs now!

Did any one else receive this letter?

It makes me wonder if NIB can do this, what about other funds? Is the surgery becoming too popular and expensive? I have been a member of Medibank Private for years, but perhaps the onslaught of people joining health funds just to qualify for this surgery is beginning to snowball and is becoming difficult for Health funds to maintain?

The Government needs to step in and make this fully covered by Medicare. Imagine how much money it would save in the long run! Australia is facing an obesity epidemic!

What do others think?

I think it is very bad......but have her call me because she has continuity and Bupa will covers it...so she won't have to wait.....I am a regional manager, and can approve discounts and claims ect...........02 46255535...doesn't matter what state you are in.......and if cost is an issue......send me a pm and ill call you...... one of our members has only been with us for 10 months and as this op is considered per-existing illness....like REALLY....she needed to wait...anyway....i got her op approved so her claim will be paid.....so she is being sleeved on march 26 13 .........and guys don't go to ISelect they make commissions.....we done actually..most phi workers don't...I just want to help....so give my office a call.....but wait until tomorrow...I am at the doctor today and taking a day of......my assistant is working but can't do approvals/discounts on premiums......

Stuff like this makes me sick......the federal government need to make this a covered item.,,,,at the moment it is considered 'cosmetic surgery" yet it has been proven that the chances of keeping excess weight off is like winning the lotto a bazillion to one.......BTW...my name is ...you guessed it Sara.......number is my direct line ....... :) ........

That is very kind of you Sara