Private Health Fund disappointment

Hi All

Just wanted to let people know I am so disappointed with AHM. I have been with them for over 20 years and had what I thought was a higher coverage policy. Unfortunately I have been told that 30511 is not covered by my policy :-( and that came as shock!

I am not willing to let that disappointment stop me from changing my life and have applied for a personal loan, until I sort out possibly using my super. AHM state that I would be covered for 30518 but my surgeon is unable to help me in that area.

Anyways think I just needed to vent!

Word of advise check your level of health cover.

PS I have now upgraded to Top Cover!

Sleeve date 28/11/11

30518 is the number you want

That sucks, MM - more and more funds seem to be declining cover these days, so you're right - check your cover. Also, some have found that there has been a change in their 12 month waiting period, which sucks even worse!

Good luck in the financial area - hope you can work it out.

you can change to another fund and serve no waiting period at all. This is a law, it comes under portability with health funds. Medibank private is a good one in my opinion.

https://www.hica.com.au/content/heath-insurance-switching

I am with AHM and I told my Dr that I was covered for 30518 not 30511. My Dr said OK and put 30518 on the paperwork. AHM paid and it was all fine. It might be worth ringing around to see if you can come to a similar arrangement with another surgeon.

30511 is the correct item number for gastric surgery for morbid obesity.
30518 is partial gastrectomy.

If you look at the claims for the last financial year on the medicare site (its amazing what you can find on the net!!) 10,000 claims for 30511 and 1,500 for 30518.

Bugger about your health fund.

Don't they realise how much you would be saving them by stopping lots of medical conditions/surgery you could have in the future if you stayed obese.
I reckon we would save them a fortune in not having hip and knee replacements just to name a couple!!

Hi All,

Just an updated note to my post about Australian Health Management they did pay some default benefits as 30511 was acceptable if performed in a public hospital.

The default amounts included, accommodation, prosthesis, anaesthetist they were not huge amounts but it contributed to lower costs for me. There was no way I was willing to wait for my sleeve.

Cheers

MMM

I'm with AHM and am covered. My gap payment is $2500.

Thats great Nessa, I stayed with AHM and upgrade our cover I do like AHM.

Good luck with your sleeve.

MMM

I had to up it from basic to top and wait the year out. Policy changed I think in June 2010 with regards to WLS.

once i knew i was taking this operation, i researched and found my fund HIF did cover under a certain level my operation. Not more than 6 weeks out i received a letter saying from 1st May they will not be covering it unless ur on the top top cover ( i am one below) and they wont cover ANY plastic surgery that is excluded on medicare even for corrective surgery after weight loss.

so not sure what am gonna do on that one - think will get closer to my goal and then look around and see what is covered where.

two reasons i loved my surgeon - he does ZERO gap so what ever the insurance pays he charges, and he does a 32 with a sewn then stapled sleeve. Out in 2 days!!! hes brilliant - he also does weight loss plastic surgery. So will have to keep an eye on his charges and maybe start saving now.

yes be prewarned and up to date on everything - as they change at drop of a hat

Hi

This is my first time posting, I just joined up. Am feeling terribly disappointed today as I found out my private health doesn't cover gastric sleeve surgery!! I thought I had basic hospital cover and found out I have been paying for something that isn't worth the paper it's written on. Lucky for me I have amazing parents who said they would pay for it. I'm so so so grateful for that. I'm looking at having it as an intermediate patient in a public hospital. It's still extremely expensive but if I had to wait 12 more months I don't think I would feel as dedicated or mentally prepared as I am now to start this process. I have been doing a great deal of research on the sleeve gastrectomy and I feel so ready to have the surgery.

I have now changed to top level cover and changed my health insurer as I feel like I got ripped off. They changed my policy and I failed to notice it (it was written in one of premium rate increase letters, right down at the bottom of the page). I tried the health insurance ombudsman and they said they had investigated the same issue previously due to complaints but because it was in a letter then the insurer gets away with it. I can't believe I have been wasting my money on something I could never even use!! Anyway, I just needed to vent after such a horrible day. I hope this doesn't happen to anyone else.

Kate

Oh that's a shame.

What is 30511 for?

My code is 30518 and im having the sleeve. Is that for the banding or something?

I got really confused between the two numbers when I looked on this thread so rang my surgeons office and was given 30518. Thankfully that is covered under my insurance.

Hi Nicole,

30518 is for a Partial Gastrectomy

30511 is for Morbid Obesity, gastric reduction or gastroplasty for, by any method

This is from the MBS website.

Hope it helps.

My surgeon also wrote down the 30518 as that is what AHM said they would cover. Now for the pre op appointments and then getting a date!!