MBF INSURANCE

DOES ANY ONE KNOW IF MBF IS COVERING THE SLEEVE..GOD I HOPE SOOO..THEY COVERD MY BAND 4 YRS AGO .SO IF ANY ONE KNOW PLEASE LET ME KNOW...

I have MBF and they covered my sleeve on July 19th last year.
Call them with the medicare item number and ask.

im with mbf and my package isnt covered for it, but im pretty sure they did say they had options where it was.

I am with MBF and I was covered for my sleeve op in April this year.

I will say though, that when ringing to talk to someone, it was hard to get a straight answer. Having the medicare number is a must. It will depend on your level of cover too.

Good luck.

well I was with ahm 4 yrs ago and they covered my band op with just hospital cover and I've been with mbf for 3 yrs now and only have hospital cover.. I wonder how long i will have 2 wait if you have 2 have extras 2 get the sleeve? hope it's not another 12 month wait!

LISSYD wrote:

well I was with ahm 4 yrs ago and they covered my band op with just hospital cover and I've been with mbf for 3 yrs now and only have hospital cover.. I wonder how long i will have 2 wait if you have 2 have extras 2 get the sleeve? hope it's not another 12 month wait!

You only need hospital cover....extras is for stuff like glasses, physio etc.
yOU NEED TO GET THE MEDICARE ITEM NUMBER FOR THE SLEEVE AND ASK THE PHI AT WHAT HOSPITAL LEVEL THEY COVER IT. Some levels of cover have certain thing excluded like joint replacements, and fertility treatment etc and they have waiting periods for pre-existing conditions. I have heard some PHI have increased their waiting period to 24 mths for the sleeve but cant confirm this. You need to call them and ask straight out "I am needing a gastric sleeve medicare item number blah blah blah, at what level hospital cover is this covered and what is the waiting period".

Thanks kylie..how is your sleeve treating you??

Hey,

My surgery is next month and I'm with MBF. I have budget hospital with $250 excess, Classic Extras. And they are covering my surgery! =o)

Well I found out today I'm covered with just my basic hospital cover.. no extra's or higher coverage..just basic hospital cover..I'm soooo happpyyyy

People should also beware that MBF do not cover the sleeve under their Choices level of cover!

Nearly screwed me over!

im getting really confused with what is covered & what isnt, i was told that ALL phi only cover the difference after medicare to the government suggested cost & you have to pay the rest yourself



ie my surgeon 3300.00 medicare refund 712.00 suggested government cost 900.00 approx



so i will get 712.00 medicare

approx 200.00 phi



out of pocket 2400.00 approx



is this correct cos thats only 1 1 item & the phi will cost roughly $1000 for the yr & $500.00 excess



so by paying an extra $1500 i will get extra $200 back - that doesnt make sense to me



i thought phi meant you paid nothing else

Okay, some PHI cover this op, it is on you to check before you have booked it in because you may be in for a surprise. You also need to add the anesthetist, again you get some back from PHI and medicare for this but it is minimal. As an example my bill was him was $2100 and I got $700 back wasn't happy about that but that's what he charged. Do your homework, if you only getting PHI you don't need extras unless you want to claim dental and optical during that 12 months shop around don't be afraid to ask do you cover this item number and if you do what is the cheapest cover it is available on. I recently changed all mine and found out that I had been paying $98 a month for top hospital because I thought I would be covered for brain surgery on a lower cover, that was hospital only, for just me I changed to family cover plus extras for only $65 extra a month. It really does pay to ask questions and be on the phone for a while....

It is all very confusing.

I found this on the internet (www.mbsonline.gov.au) when searching for item number 30511 which is the number I was provided by my surgeon for the Gastric Sleeve:

Fee: $817.35 Benefit: 75% = $613.05

This means the Government says the sleeve surgery should cost $817.35 (the scheduled fee) and they will give you back $613.05.

If your PHI covers this op and you have hospital cover they will pay the difference up to the scheduled fee which is $204.30 and should cover your hospital costs (you may have an excess to pay).

The issue is that your surgeon may charge you whatever he/she likes. In my case, it is $4500. So my out of pocket is $4500 - $613.05 - 204.30 = $3682.65. On top of that there is the Anethesist fee which in my case about $1000. I also have a small excess on my hospital cover.

I think the reason why MBF don't appear to be helpful is that they know the surgery costs thousands of dollars and they don't want to be the one to tell you that you will only get 200 dollars back from them (plus your hospital fee if you have cover).

The government needs to take a look at the actual cost of this surgery and consider increasing the scheduled fee. I am sure that this would apply to all surgeries.

True, and yes you are out of pocket that, but your health fund pay your bed, therate fees, assistant surgeon fees my statement showed it was $14,000 all up, I would rather be out of pocket $4500 or whatever it may be than the other amount. To be honest, and this will be blunt, you are doing this because you want it. There are reasons why, at this point in time, it is NOT offered through the public system. If you have the funds and you want this, you will make it happen.



If you don't get insurance because you are annoyed that after the 12mths plus the out of pocket costs I am at this much $$$$ out of pocket what's the point? Well go in and pay for the bed, private hospital a shared room is approx $700+ a night more if you have your own. Pay for the therate costs and the assistant surgeon.



Now I understand money is tight for a lot of people, same in our house. So I get that you want to find the best deal for you but to be frank you are better off getting cover that will cover the sleeve for the 12mths to have it done.



Sorry to offend anyone, I am a blunt person.

I am with MBF and they are covering it. $250 excess but I did make sure by phoning them and quoting the item number first.

I have rung them and they told me that they do cover it. You shouold ring them and double check for your level of cover - make sure you quote them the number. I am going to phone again this week and double check. Sleeve on 28/03 and I don't want any nastly little surprises to ruin my life changing moment!!

Jace68

They covered me. I rang and quoted the item number beforehand to be sure. I was glad. they estimated my bill for the surgery at my choice of private hospital was $17,000. I had to pay $250 excess and pay my Surgeon $5000 (Dr. Craig Taylor) but that $5000 covers all follow up appointments with dietician, Dr Taylor and psychologist so I think its great value.

LISSYD wrote:

DOES ANY ONE KNOW IF MBF IS COVERING THE SLEEVE..GOD I HOPE SOOO..THEY COVERD MY BAND 4 YRS AGO .SO IF ANY ONE KNOW PLEASE LET ME KNOW...

I work for Bupa and they do cover the sleeve, you will need to contact them to find out about. Your level of cover. Inbox me and I can check it out for you, or explain it to you.

Apparently you will need top cover, but hospital only to cover the sleeve....the wait period is only 12 months as it is classified as per existing illness

Anyway....hope this helps

Sara.....I am being sleeved on the 20th of March