PLease help me understand these emails.....

I have been trying to find out if i have a waiting period.....
it reads from the bottom up


Dear A
Thank you for your recent email.
Your current level of cover is Top Plus and General Extras Plus.

Please be advised in regard to your query for been admitted in to hospital for item 30518. Due to that HCF has received the Clearance Certificate information that you have transferred to HCF from another health fund we can confirm that you have continuity of cover and the below would apply if you were admitted into hospital.

HCF will cover your accommodation and theatre charges in a public or private participating hospital for 30518.
A list of participating private hospitals can be found at: http://www.hcf.com.au/Services/participating_hospitals.asp?member_id=Guest&urlID=2234365|1
You pay your excess of $250 payable if you are in for an overnight admission. Please note this excess does not apply for same day surgery, admission due to accident and dependent children.
HCF covers 25% of the Medicare scheduled fee for any doctors services provided while you are admitted to hospital (i.e. in-patient service). Medicare will cover the other 75% of the Medicare scheduled fee.
I would suggest you ask your surgeon whether they are prepared to charge you at the HCF no gap rate so that you do not encounter an out of pocket expense. This equally applies to any assistant surgeon, and anaesthetist.
HCF will cover 100% of the no gap rate for your prosthesis provided the item is listed on the commonwealth schedule of surgically implanted prosthesis and human tissue. If the doctor charges a gap you will need to cover the difference between the charge and this fee.
Please be aware that for any tests, scans or consultations that take place when you are not admitted to a hospital or day facility (i.e. out-patient services), HCF will not be permitted to contribute any benefits.
The hospital will bill HCF directly, whereas the doctors bills will go to you. You would submit the doctor’s accounts to Medicare, and then forward the Medicare statement to HCF.

For auditing purposes we do require the attached from to be filled out if you are admitted in to hospital due to that you have upgraded your level of cover with HCF when you have transferred from your previous health fund.

You can return these by fax to 02 9248 9423 or by post to GPO Box 4242, Sydney NSW 2001, or by email as scanned attachments.


Should you require any further assistance please contact us again.

Sincerely

HCF Customer Service



Hello,
You have not answered my question.
I do not have an upcoming hospital admission, i am simply trying to work out if my current cover would cover item no. 30518 and if i have a waiting period. If i have a waiting period you need to advise the date that the waiting period would cease.

- A




On 20/06/2011, at 11:09 AM, service@hcf.com.au wrote:

Dear A

Thank you for your enquiry regarding your upcoming hospital admission.

I apologise for the delay in responding to your email as we have experienced an unexpected increase in the number of emails we are currently receiving.

At this stage HCF is unable to confirm your cover for surgery as you have served less than 12 months membership with HCF and upgraded your cover when you transferred to HCF.

Before cover can be confirmed we require the attached form to be completed by your GP and returned to HCF's Clinical Review Team.

You can return these by fax to 02 9248 9423 or by post to GPO Box 4242, Sydney NSW 2001, or by email as scanned attachments.
Should you require any further assistance please contact us again.

Sincerely

HCF Customer Service


----- Original Message -----


Please contact me by: email
Comments/Request: I am wondering if under my current cover if i am covered for item no. 30518 and the hospital stay involved. Will there be any waiting periods?

The form btw asks the doctor how long i have been a patient and how long i have had the condition.

I interpret this information to mean that you have a 12 month waiting period as being overweight is a pre existing illness.

Hi Autumncurl,

That is a very complicated response from HCF!

This is how I understand it: yes, you are covered for 30518. Please double check this with HCF.

Hospital stay

HCF will pay for your hospital stay, and you will pay a $250 excess toward this.

Surgery

Medicare will cover 75% of the scheduled fee and HCF will cover the other 25% of the scheduled fee. The 'scheduled fee' is a Medicare term. It is a much smaller fee than your surgeon will actually charge. For example, if Medicare says the surgery should cost $1000, it will refund you $750 and HCF will pay $250.

However, unless your surgeon uses the 'HCF no gap rate' there will still be a gap to pay. For example, your surgeon might actually charge $5000 to perform the surgery, in which case, you would need to fund the extra $4000 yourself (the gap). You need to check this with your surgeon. Most surgeons DO charge a gap.

Assistant surgeon and Anaesthetist

You need to contact these people directly and ask what the out of pocket costs will be. Likely, Medicare will cover some of the cost, HCF will cover some, and you will pay the remaining gap.

Instead of relying on email, I would call HCF and speak to a person who can break it down for you. There are so many things to think about, that it can get really confusing. I hope it all comes together.

(Just one thing I am not clear on is this: between your old fund and your new one, have you served 12 months? It looks to me as though you have. It also seems that you upgraded your cover when you transferred to HCF, but that the old fund would have covered you at the lower level, which is why HCF will now cover you for this surgery with no waiting period. This is how I understand the email, but please confirm with HCF.)

MiddleWoman

thats i how i understood it..however i have asked twice what the LENGHT is of my waiting period if i have one and this has not been answered.. going to print the emails and go to the office...grr

Ok so i went and talked to them and the lady said i have to wait until 17th of January. which is annoying.

Hi Autumncurl

WOW talk about saying one thing and meaning another?? That is why I shutter even thinking about changing health funds!

But I am with Middlewomen on this one.

MM