HBF Cover Confusion

Hi everyone.

I have glanced over a few older posts, But I am still so confused.

Something was telling me to ring HBF to double check, triple check my cover. I am covered for the sleeve surgery..

I have the Smart Saver Twin Pack (I think thats what its called)

However, they still managed to confuse the heck out of me, the gentleman on the phone got me rather excited at the fact they would cover surgeon fees and gas man fees.

He asked the item numbers and the cost for each one.

So... the quote I received from my surgeon states $4000 (I assume that this is just for item number 30518?)

I have no idea what the item number is for the gas man? Can anyone help me with this?



Anyway.. HBF advised that the surgeons fee is higher than the agreed value between the surgeon and HBF so they cannot cover it. HBF said there could be more item numbers that the $4000 fee is broken up into.. Does this make sense?

I always thought I would be paying the $4000 out of my pocket anyway.. I'm just shocked to hear that they do cover partial or all surgeon fees as well as gas man fees.

Can anyone explain this mumble jumble to me?

Thanks all.

Hi delly

I'm with hbf single savers

I am fully covered besides the surgeons fee of $1600 however they told me once I have the surgery to submit my invoice to Medicare and then hbf again and I might get done more back

My gas man was fully covered as well

Don't know if this helps lol

Some surgeons charge a higher fee for booking that is not covered via hbf however the surgery part is fully covered

Gas man has same item number as surgeon, the item number is related to the procedure, not the health professional.

As far as money back, medicare will refund 75% of the "SCHEDULED" fee and PHI the other 25%. The gap payment comes from the difference between what the scheduled fee is and what your surgeon/gas man actually charges, there is almost always a difference. Its the same as how when you see your gp then claim from medicare but you don't get it all ack, its because your gp charges more than the "scheduled" fee, its usually because most gps only will get less than $5 per patient after insurance, rent etc if they only charge the scheduled fee, the scheduled fee just doesn't seem to be in line with the actual cost of things.

Hope that makes sense.

Delly,

Hi,

The medical scheduled fee scheme is what the australian governement says that a procedure should cost, however it is the doctor disgression to charge what they want to, you would (most likely) be covered for the hospital stay and your put of pocket cost is normally what is left for you to pay once the doctor has gotten the medicare benefit, in my case it was $3,900.00 but every surgeon is different...some charge as high as $8,500 plus....

Other item numbers could be:

17610--- Anaesthetist, pre consultation

20791---initiation of managemetn of anaesthesia

23082 ----1:51 to 1:55 hours (standard for this type of surgery)

and 2500---anaesthesai, perfusion or assistance

Thank you all for your input.

It all makes much more sense :)

HBF love to confuse you don't they.