An intro to private health insurance - Australia (read if you have questions)

Just passing on my knowledge of private health and how to make the most of it!:

1. Take out top hospital cover with an excess. The reason for this is it reduces your premium and therefore you pay less and if you should get on the public list, and decide to cancel private health insurance, you'll have lost less. In the meantime, save a few dollars each week. For example, check out the link below.

http://www.medibank.com.au/Health-Covers/About-Hospital-Covers/First-Choice-Saver-Hospital.aspx


also make sure that your doctor participates in the access gap scheme. This means your doctor is registered with the company you choose, you will therefore get better benefits back. If your doctor isn't with the company you choose, you will have higher out of pocket expenses.

If you are over 30 years old, you will be charged higher premium rates so make sure you check out the % of these.

Now, if you take out Level 2, on the day of your admission you will need to pay $300, and with the daily co-payment you will be paying $50 per day for the bed. So, budget the next 12 months to save $1000.00...or $20 a week...you can save $20.00 a week...I bet you've paid that in the past for a weight watchers meeting per week.

2. Take out intemediate ancillary cover. If you were unfortunate to need nursing care at home, i.e wound infection, you'll be covered (but probably still have a gap), otherwise you wont. It will also cover some of your dietician expenses as an outpatient. Make sure the cover includes dietician. Otherwise, visit your GP for a "care plan" posted in the financial forum.

Some intemediate cover also has a claim for healthy lifestyle. So, you can buy a pair of new joggers or join the gym and wil get a rebate, small amount but better than nothing. Waiting time for ancillary is two months. After that two months you can claim for non pre-existing conditions. So, no check ups until it kicks in!!! During the time you have it, make an appointment to get your eyes checked, this is free at optometrists as it's covered by medicare. Then, if you need glasses, use your private health ancillary to claim. Also, get a check up at the dentist and claim that. You'll be able to claim for a scale and clean and xrays and fillings. This way, you are effectively getting your premiums back. Sneaky but worth it.

Any blood tests, xrays/scans, physio, dietician as an inpatient will be covered but you will be billed separately for these as they are private companies contracted to the private hospital so you will get a few different bills. You may have to pay a gap on these. If these tests are done on a weekend, you may have a higher gap.

So:

1. Choose a doctor

2.Choose a hospital

3. Get cover that recognises your doctor and hospital to reduce your gap

4. Read the government private health website
http://www.privatehealth.gov.au/

5.and choose a company in your state - less hassle should something go wrong with red tape!
http://www.privatehealth.gov.au/dynamic/searchbyinsurer.aspx

Once you have item numbers, available from the doctor, you will be able to ring the health fund and ask how much the benefit is so you can calculate your out of pocket expenses.

but not until you understand what you need!!

My personal opinion: If you get through 12 months of paying health insurance and it hasn't greatly impacted on your finances, then stick with it, don't cancel it after the surgery, you never know if you will need it down the track. You can reduce the level of cover to cut your costs and then increase it later but will have to serve waiting periods as per the health cover you have.

I am not with Medibank Private, that link I posted is just an example. I pay $54 a fortnight with my fund. I am single and have no age co-payment. Comes straight out of my pay so I don't miss it (is that an option for you?? ) I have top hospital with a $200 excess, and intemediate ancillary cover. I could actually drop down as some services i don't need. Last time I worked it out, if I was finacially STRAPPED, I could get away with a $25.00 fortnight premium! I would certainly do that if I got cash strapped. I wouldn't give up my private health insurance.

I would seriously hang on to the basic minimum private health post surgery if you have taken it out in case there are any problems down the track.

Remember even if you have a partner and a family you are still allowed to take out single cover just for yourself. this can save you a LOT of money when it comes to health insurance if you are only taking it out to cover your for surgery.

applesauce

changing health insurance company portability scheme

http://www.privatehealth.gov.au/information/takeinsurance/leavefund.htm


problems with your current health insurer that you are unable to resolve directly with them:

GO to:

http://www.phio.org.au/

The governemnt private health insurance website is really good and alot of your questions can be answered there.
Read it before taking out cover

http://www.privatehealth.gov.au/

I am with HIF on Goldstar top cover.

They paid for all Hospital Costs except the Seamguards ($460) used to seal the staple line on the stomach (not all surgeons use these).

Apparently The Insurance Company and the Mount Hospital do not have an agreement over who should be paying for these.

After both the Mount and HIF refused to pay I sent in a complaint to the Health Insurance Ombudsman.

This in turn caused HIF to bring it up at a Member Action Review Committee who have agreed to pay for it.

HIF have also told me that they will discuss including Seamguards with the hospital when the contract comes up for review in a year.

I know some of you have had the same claim knocked back, so hopefully this information will help if you still want to fight for it on principle, or any other item you feel should have been included.

Peter.

Thanks Peter, I was with HIF but left but I had no gap for anything, except a small amount for the surgeon and $7 of phone calls, but that is cause I work at the hospital otherwise I would have had a bill, I am not sure if I have a sleeve guard as I remember the dietician mentioning it pre-op but can't say for sure for 100% as I dont remember the surgeon saying it. But if he did it was definately covered and maybe thats cause you made the complaint and got some action!

edit to add I was going to say something to the hospital about charging my phone calls but decided to keep shut in case they reversed my staff credit.

Seamguards are not standard for most Surgeons. The majority just use Glue.

I believe the charging issue varies hospital to hospital and depends on their specific contract with the insurer. Basically from what I have found if there is no contract between the two for a specific item, it is supposed to be the patients responsibility.

But it is also both the Surgeon's and Hospitals responsibility to inform the patient of these extra costs. In my case neither informed me, which is why HIF ended up paying.

At the Mount local calls are included in the HIF contract, but Mobile/STD were extra.

Peter.