Medibank Basic Hospital cover query

So today I spoke to a representative at Medibank private. Told them I wanted to see a doctor about my weight and that I was advised to consider PHI if I didn't already have it in case I go on to have a gastric sleeve (here's hoping!) Anyway I quoted the item # 31575 and asked what is the cheapest level of cover they have that will cover this procedure just in case I might need it one day. He went away for what seemed like ages and came back and said he'd double checked and the Basic hospital cover will cover it at apprx $88 per month (single cover). And to top it off providing it's considered medically necessary by a doctor and not pre existing condition then it's a 2 month wait not a 12 month wait. Being that I haven't seen any doctors yet or been told to have the surgery, he didn't think it is considered pre existing. I've now spent an hour going over Medibanks website and they do not mention the words obesity surgery, weight loss surgery, gastrectomy, banding, sleeve or item # 31575 at all. But everything he said to me seems to be the same on the website.

So can you please share your Medibank experiences with me regarding level of cover & waiting periods? I haven't taken it up yet as it seemed too good to be true and we all know what that usually means.

As a matter of interest Bupa & HCF quoted me $106 & $102 per month to cover bariatric surgery with a 12 month wait.

Hey Soren, I am with Medibank but have top cover. I am sorry to say that I can't imagine that advice being correct as a "pre-existing condition" is not the same as not having had a recommendation for weight loss surgery. I would imagine that any past record that your doctors have of weighing you at an obese weight or discussions about your weight would be more the evidence of that. On top of that, Medibank would surely not open themselves up to an inundation of people wanting this surgery if people could just pay two $88 payments before they could have their op. Thousands of dollars for a less than $200 investment just doesn't add up to me - I just think Medibank would have to be too savvy for that.

I hate to burst your bubble though, so please do check further if you think you have a chance. However, my understanding is that top cover is required. I will be really interested to find out otherwise.

Best wishes, please keep us up to date with what you discover.

Thanks for your reply Wonda. I completely agree with you. This is why I posted in here to see what others may have experienced. I will be calling them back tomorrow and speaking to someone else. I don't mind about the 12 months wait if that's what it is. $88 a month is still cheaper than $106 with Bupa.

Just make certain your level of cover includes WLS as I know there have been a couple of people on here who have waited a while, then then found out they weren't covered and have had to start their 12 month wait all over again.

I personally didn't take out my cover specifically for the sleeve. I took mine out last September after having to pay several thousand for nasal surgery and deciding that as it was my 6th surgery for various things I never wanted to have to worry about these things again. Then this Easter hols I discovered and decided to have the sleeve. So my wait has been less than 6 months, but has felt longer, lol. Even though I had top cover, I didn't even feel that I could ring and check that I was covered for the sleeve as I was paranoid that somehow they would be "alerted" and as I hadn't done my 12 months, I would somehow be prevented from being covered. Ha ha! Paranoid?

Sorry to tell you but being obese is definitely pre existing. It doesn't happen overnight. Also I don't know one PHI that does WLS on their Basic Cover. Except maybe if you have it as a Intermediate patient in a Public Hospital but you'd have to check if that's available in your area.

Thanks everyone. So after numerous phone calls, yes it is pre existing condition. Yes there's a 12 month wait. But Medibank is $25 a month cheaper than Bupa for me for a level of cover that will definately cover the gastric sleeve with a private doctor in a private hospital. My 12 month wait begins today!!

Don't forget to save money too as there is almost always a gap of around $5000-$6000 on top of the Health fund that you have to pay out of your own pocket.

Hi All

I had my sleeve done in Feb this year and am with Medibank Private. I was with NIB and when I asked about the sleeve late last year  they wouldn't pay for the op on the level of cover I was on. I had just reduced my cover after having my last child in September and I was apparently past the 2 week cooling off period. I had been a member of NIB for 18 years. They didn't care.

I shopped around and joined Medibank who were all too happy to cover me for my sleeve on the basic hospital cover. I just had to pay a $500 excess. Seven months down the track, my hubby is going in to have his sleeve done tomorrow. Again covered by Medibank although you still need to pay the gap which is about $6K. Better than the $20K plus without health insurance.

Good Luck

Kristie

Hi Maryle, Thanks for that tip. Yes I have had quotes from various private surgeons in SA and they range from $3250 to about $4000 out of pocket expenses with them and the anaesthesitist. Plus there'll be the $500 excess payment with medibank.

Congratulations Kaycee!

Hi Soren,  was reading your posts and am wondering how you got on in the finish with phi??  I have cover with medibank private called family essentials - costs me $220 a month and im about to ring them to see if it covers my sleeve. Hope so, dont need to wait any longer than i have too!!!

Hi elkagirl. Sorry I haven't been back on here for over a month. So I took out medibank private basic hospital cover. I triple checked that it will cover the sleeve. I took out singles cover only even though I have a husband and kids. This just means they still have no hospital cover and I do. It's $40.15 a week or $88 a month for just me and does not include glasses, dentists, physio etc. Just hospital. I have a $500 excess to pay if I go into hospital also. Included in that is 12% extra due to being 36 when I took out the cover (2% for every year over the age of 30).