Advice re: Insurance pls! / follow up, very disappointed :(

I took out top level health insurance through Police Health last month as my hubby needs some surgery on a crazy wisdom tooth and a fast paced lifestyle for my boys ( while I sit on the sidelines ) which I want them to be absolutely covered as best I can manage. Sleeving hadnt honestly even occured to me until last week, I didnt think I was big enough for it ( BMI 35 ) So im wonderring if because I am fat, and have been for 10 years....is this what they consider a pre-existing condition? ( i realise how rediculous this sounds as Im typing it!) Or is it a pre-existing condition when I go to my dr and am considerred suitable for surgery? Am I better not approaching my dr until im closer to 12 month of being insured??? Or should I be letting her know more about my conditions like chronic snoring and frequent nightly waking, joint pains, back pain etc, which I had been struggling through on my own without treatment for? Does any of this make sense? lol

many thanks for any advice and experiences

Hi Mobius, and welcome to the forum
I don't know about Police Health, but I do know that lots of people have joined a fund just so that they can have the sleeve.
Since you've already joined now, I think it's safe to talk to your doc about your problems, and also think it's a good idea to do so.
I do not think that being overweight previously will stop you claiming on your health insurance - or else most of us would have the same problem, and as far as I know, no-one has.
And at a BMI of 35, you are on the low side, but I do know of people with slightly lower BMIs who have had the surgery. Again, talk to your doc.
Best wishes with your research and decision on how to proceed.
Chris

Hi
pre existing stuff you hace to wait 12 months for . You have to wait 12 months to go to hospital anyway and usualy for big dental stuff to. Don't worry about your weight being pre existing complaint it is like that with all of us that do this surgery , not something that just happened over night ,lol. easy to piut on harder to take off. All I can sya is happy waiting and in the mean time resherch this and find a great dr inyour area

many thanks ladies, Im in here alot researching, what a wonderful resource this site it!

Plenty of people organise thie surgery before they have completed their 12 month wait. they get all the visits and checks done about 3 months before and have their surgery booked in for a few days or a week after the 12 month anniversary of their joining their fund. Nothing silly at all about getting it organised. Lots of sleevers with bmi's of 32-35. It is ONLY going in as a public patient that the guidliness say you should be a bmi of 40 and above so being smaller then can present a problem some times.

Check out now which surgeon looks the best for you. All have different aproaches and locations and of course there is HUGE price differences between them as well. As in the gap left over between you private health cover and what you have to pay out of pocket. this ranges from 0 for one doctor to close to $6,000 for one of the most expensive ones. there are lots in between as well. So again shop around here in perth you have the time :)

applesauce

Hi Mobius

I have done the same, I took out insurance in Jan & have to wait. When I organised my insurance I let them know what I was going to do & they stated that I'd need top level hospital etc & would need to wait the 12mth waiting period before I could have the surgery. I have already chosen a surgeon & am booked in to see him in July to start the process. Check out all the areas of this forum as it's a gold mine of info.

good luck with the decision
Colleen

Hi Mobius,
your chronic snoring and joint pain could possibly pass for co-morbidites. If you have knee pain, perhaps you may have some arthritic changes? An X ray will show this.

The other thing that your bariatric surgeon probably may require for a candidate with low BMI is evidence that you have tried dieting / weigh reduction of some description (eg joined Weight Watchers etc).

Something to be aware of is that a lot of GPs do not know much about sleeves! The Lap Band company is shockingly efficient in promoting their products - one of my GPs had a stomach model wiht model lap band in their office!

I did a lot of research, and actually printed out a couple of articles - one explaining about the sleeve, the other comparing outcomes from the sleeve VS the lap band.

I pretty much walked in and told my GP I wanted a referral to surgeon X and gave him my articles to read!

Sophia
PS I had a BMI of 36, with significant family history of diabetes + osteo problems

Im so upset!

Just rang Police Heath and gave them the medicare item number for the surgery....the max they will pay out including gap cover is just over $700 bucks! And thats after a 12 months waiting period.

Im guessing surgery will cost between 7 and 10 thousand....$700 back from health insurance is just not going to allow me to get this done :(

I could cry right now :(

Hi Mobius
I'm so sorry to hear that your health insurance won't come to the party.
How about changing companies, though?
Also, do you have any super that you can access? A lot of us have had to do that, too.
Good luck.
Chris

it is your hospital stay and theatre fees that are covered most by your private health insurance. this money makes up the bulk of the bill. The $700 surgeon fee is pretty standard , plus you get a medicare part as well. Most people end up with a gap ranging between zero and $6,000 depending upon the surgeon you choose. You can shop around and find a surgeon with a lower gap. I am not sure there is any other surgeons besides one in Perth with a zero gap tho, most gaps are around the $3,500 mark.

applesauce

Quote :

The $700 surgeon fee is pretty standard

Im so floored by this! Its not like the money is going to a trained monkey....these are professionals who of course charge professional fee's! Thats just shocking to me, Im lucky to have not needed healthcare too much I guess, so its all a bit new to me.

Chris, yep I have 3000 in super Im hoping to be able to access, this might just keep me in the running to get the surgery *fingers crossed!* I think I will be looking around for other insurance as you say, I chose Police Health as their brochure suggests 100%Gap Cover....I thought it was a perk for having a family member in the force ( HA! fool me once...)but apon reading it a fifth time, I can see how they have carefully worded it so as to be able to confuse the purchaser and its that 100% of their customers have gap cover.... not 100% of the gap being covered as I understood it to be. grrr!