Private Health Insurance

[Raz]

^^ would that depend on other medical conditions though? My sister has a certain medical condition, and has had to have that many consultations and ultrasounds with a specialist obstetrician throughout both her pregnancies, who is damn pricey let me tell you, and I am almost positive that her and her b/f's health fund covered a certain percentage of those consultations..

I'd have to check though, but I highly doubt the pair of them would have been able to afford that doctor, let alone chosen to get pregnant a second time and go back a second time to that doctor without some coverage from their health fund...

(when the doc told me at my nephews birth the round about figure of how much he earnt just from being at my nephew's birth, I literally fell over!)

I probably could have explained it a bit better, but I didn't want to complicate the issue; once you start getting into this stuff there are layers upon layers...it's possible that your sister's consultations may have had benefits paid towards them, but unless she was admitted (even as a same-day admission), it wouldn't have been from hospital cover.

Basically, there are two types of cover; hospital cover, which provides benefits for inpatient medical treatment where medicare provides a benefit, and ancillaries (or extras) cover, which provides benefits for specialists where you don't receive a benefit from medicare...for example, dentists, physiotherapists and chiropractors.

On top of this though, there are some products which offer other perks....for example, medibank has a product which is called packageplus, and I'm pretty sure other health funds would have something similar. With one of these packages, you have hospital AND extras cover, and you also have a "package bonus"; a separate pool of money which accumulates every year and can be used to pay membership and health-related expenses. One of the things you can use this for is health screening services where medicare doesn't pay a benefit.

What that means is that if your sister has a package (or whatever other funds call it) and had an ultrasound that medicare contributed nothing for, she could have used her package bonus to pay for it. It would really be the only way she could pay for it, unless she had a one-day admission to hospital, in which case she'd be classified as an inpatient (even though it's only for a couple of hours), and could use the hospital cover without a problem.

Hope that all makes sense, I know it's pretty convoluted...

SLM, re:Dale getting cover....the way I always explain it to people at work is that if you never intend on getting hospital cover, then the LHC loading won't affect you so don't worry about it. If you're over 30 and you know that you will want to get hospital cover at some point though, you might as well do it now even if you aren't planning on using it for a while....because while you'd be paying for something you're not using for a while, it's probably cheaper than the combined extra loading you'll be paying for the rest of your life when you finally do get around to joining....

 

[Strawberry_lovemuffin]

That's a good point, can you explain it to HIM?

BTW, what's up with your phone.

 

[Samadhi]

Get a clue.

Everyone in Australia should have public hospital cover? Private health insurance is a rort? Boohoo, poor me, I only earn $60,000pa and have to pay 1% out of my pay for a medicare levy, how terrible!

Medicare was NOT introduced for everyone, it has been abused and now we're paying the price. Medicare was introduced for families, people on low incomes and older Australians. Not for single people or couples, earning ridiculous amounts of money, who will quite cheerfully buy expensive cars, furniture, holidays, drugs, go out to restaurants on a regular basis etc etc etc, who wouldn't dream of not insuring their cars or houses but won't insure their own health.

Do any of you read papers? Watch the news? Our Health system is in a crisis at the moment and its not just Qld. There are many reasons for this, and it certainly hasn't been helped by the abuse of a system by a lot of Australians who are, quite frankly, spoilt, selfish children who think they aren't responsible for their own health.

Please, to those people earning a decent amount of money - stop acting like its your right to use the public health system and leave it for the people who really need it.

And yes, quite possibly private health insurance is a rort - much like other types of insurance but hey - that's life! Being screwed over by big corporations is a reality! 8)

Also, having private health insurance not only doesn't guarantee a private room, 9 times out of 10 you wont get one anyway since most people share a room in private hospitals and private rooms are kept for those that are seriously ill.

The advantages of private cover are being able to choose your own specialist and not being on a lengthy waiting list for so called 'elective' surgery (the definition of which is surgery which is not required in the next 24 hours). Trust me, if you ever get sick or are diagnosed with a medical condition, you will appreciate this.

Couldn't agree more, Sunflower. As soon as i started earning decent money, we got private health insurance. We also opted for orthopedics (Mr S has bad knees, and obstetrics, as we're considering extending the samadhi family this year, finally).

I don't care about the private room, really, i've been in public before, and all you have to do is close your curtain

I also got the othodontics cover, becasuse frankly, i believe that dentistry is a racket that is relatively unregulated. THe differences in prices for a filling in the CBD and in the outer suburbs is amazing.... $300 - $80. I need braces as well.

 

[toerag]

ah thanks raz, that did explain things a bit for me. and got me thinking more about my health insurance... time to start shopping around some I think and see what others can offer me and how much it will cost me.

 

[*sunflower*]

SLM - Its been abused because people who earn a substantial amount of money use the public system when they can afford to pay for their own health care. I pay $75 a month for private health insurance and earn $50,000 pa as an 8th year RN (after working public holidays/weekends, being in charge etc) - sorry if you're offended, but come on. I'm coming from a completely different place to you. I am an educated person, earning crap money (compared to people in other professions), looking after people who earn $20,000 pa more than me who are using the public hospital system. It gets to me somewhat.

I'm not saying (by any means) that this is the reason for our health crisis - but it doesn't help - it has made things so much worse.

I will quite happily pay out of my taxes for people and their health care with children, older people and people who don't earn a lot of money to have access to free hospital cover (public hospital system) but NOT people who earn over $50,000 per year who are single or in couples who, by most of the world's standards, have an excellent quality of life.

A lot of people need to take responsiblity for their own health cover. Its common sense.

In any case, in the future, our current government will most likely introduce means testing for the public hospital system. I've been hearing about this for around 8 years or so.

Something to think about.

 

[*sunflower*]

Yep

I also got the othodontics cover, becasuse frankly, i believe that dentistry is a racket that is relatively unregulated. THe differences in prices for a filling in the CBD and in the outer suburbs is amazing.... $300 - $80. I need braces as well.

Agree. Dentistry is a racket and it pays to shop around. I've found this out myself - p.s. I had braces 5 years ago and most orthodontists will offer a plan where you pay off so much money a month. I paid upfront but was lucky as I had the money at the time.

Private health insurance shits me to tears. But as a single person earning a decent amount of money I really can't complain.

 

[The Lady Of Rage]

I assumed my health insurance that I am paying about $120 per month for included ambulance cover so it was a shock to get a bill for $550 that wasnt covered by my insurance when I needed one recently.

Its not worth the money to have IF you dont get sick...but thats a big IF.

 

[Samadhi]

The Lady of Rage: In QLD, by paying our electricity bills, we automatically receive ambulance cover. Is it not the same in other states?

 

[CHiLD-0F-THE-BEAT]

^Nope. 8)
Never heard of a system like that... that's utterly bizzare.

 

[Duckboy]

^But in Vic, if you pay car rego, you automatically get 4 speeding fines and a free yellow sticker.
And if you pay your water bill, you get a lovely letter telling you not to use any. Water usage goes down, govt finds they're not getting as much money, so water rates go up. Yay.
Ambulances be damned!!

 

[hoptis]

The Lady of Rage: In QLD, by paying our electricity bills, we automatically receive ambulance cover. Is it not the same in other states?

Every state is different apparently. Vic is membership or large cost on emergency use, NSW version of memership is being covered by private health ambulance cover.

As I said before, don't assume that private health with ambulance will cover your ambulance costs in all situations. Ask your insurance provider when you sign up just what ambulance cover actually means, in some instances it can mean emergency's only so you have to pay for medical transport in non-emergency situations.

 

[Raz]

^^^what hoptis said...different states have different rules...ring and ask eh?

 

[astrosmurf]

i just saw an ad on tv for ambulance cover, $55 for singles and $110 for families for year long cover (in victoria).

here's the link for interested people: clicky

 

[The Lady Of Rage]

IMO there should never be a gap with health insurance, it should cover the total cost of a hospital visit.

 

[Samadhi]

With our health insurance, we opted for the $250 gap per person, for any hospital visit. I pretty much demanded a guarantee that that was ALL we'd pay if we needed a stay in hospital. It sucks though, there's a gap with all insurance...

 

[Strawberry_lovemuffin]

i just saw an ad on tv for ambulance cover, $55 for singles and $110 for families for year long cover (in victoria).

here's the link for interested people: clicky

Yah, it's fuck all. Even if you don't have private health cover...

GET AMBULANCE COVER.. it's Cheap as fucking Chips!

... and will save you a bundle.

PLUS, if you're ever in a situation where you think you might need an ambulance (like I was the other weekend), you'll never have that "will I or won't I?" doubt, you'll just do it. Because you're paid up and it doesn't fucking matter if you're wasting their time or not...

I just did a refresher St. John's Ambulance First Aid Course today, and they always stress - it's MUCH better to call an ambulance out if you don't need it, than not call it, and you possibly DO need it. The Ambulance guys don't CARE... there are enough of them (luckily) to handle most emergencies, they are actually *relieved* if you don't actually want them... the police are NEVER called unless there's a death, and they don't question you or ring your parents or any shit like that if you've taken drugs, they just take care of you, no questions asked.

I think anyone who takes ANY illict drugs and does not pay $55 a year (or whatever it is in your state) to be covered for an ambulance seriously needs their head red.

 

[Samadhi]

^^ Couldn't agree more SLM. LIke i said in my earlier post, in QLD, Energex & other electricity companies such as Ergon have created an initiative with Qld Emergency Services whereby when customers pay their electricity bills, a portion of that gives us ambulance cover. Odd, but IMO, really good.

I worked for Ergon enegy a few years back, and you'd be surprised at the number of people that complained about the extra $12 per quarter that they were paying for ambo cover. I can understand people that own numerous properties, but IMO, if you can afford numerous properties, you can afford to cough up $12 per quarter.

 

[THR!]

Get a clue.

Everyone in Australia should have public hospital cover? Private health insurance is a rort? Boohoo, poor me, I only earn $60,000pa and have to pay 1% out of my pay for a medicare levy, how terrible!

Medicare was NOT introduced for everyone, it has been abused and now we're paying the price. Medicare was introduced for families, people on low incomes and older Australians. Not for single people or couples, earning ridiculous amounts of money, who will quite cheerfully buy expensive cars, furniture, holidays, drugs, go out to restaurants on a regular basis etc etc etc, who wouldn't dream of not insuring their cars or houses but won't insure their own health.

Do any of you read papers? Watch the news? Our Health system is in a crisis at the moment and its not just Qld. There are many reasons for this, and it certainly hasn't been helped by the abuse of a system by a lot of Australians who are, quite frankly, spoilt, selfish children who think they aren't responsible for their own health.

Please, to those people earning a decent amount of money - stop acting like its your right to use the public health system and leave it for the people who really need it.

And yes, quite possibly private health insurance is a rort - much like other types of insurance but hey - that's life! Being screwed over by big corporations is a reality! 8)

Also, having private health insurance not only doesn't guarantee a private room, 9 times out of 10 you wont get one anyway since most people share a room in private hospitals and private rooms are kept for those that are seriously ill.

The advantages of private cover are being able to choose your own specialist and not being on a lengthy waiting list for so called 'elective' surgery (the definition of which is surgery which is not required in the next 24 hours). Trust me, if you ever get sick or are diagnosed with a medical condition, you will appreciate this.

For fucks sake, that attitude is wrong. A bit of a belated entry into the discussion but the rich (or at least those earning over $50k, which is fuck all) are the ones that sustain the health system for the rest! And we're basically excluded from using it because we need to purchase private health cover anyway! Now I'm not saying that we shouldn't contribute - but we pay higher taxes anyway - we should at least be able to use it without being ridiculously penalised! Essentially a lot of people on $51-$60k can be in a worse position than those on lesser amounts.

 

[THR!]

I'm not sure if you meant to say health insurance here but regardless this is an excellent point.

If you sort yourself up with life (inc disability insurance) now (assuming you're young), its way way cheaper and stays that way for the rest of your life.

Incorrect. You can have a level premium up to a certain age (typically 65), when it reverts to a stepped premium. When you elect a level premium, you subsidise your premium later in life by paying more earlier in life.

For most people, either the premium increases or your Sum Insured decreases. So there is typically no advantage in taking it out younger (although I am a definite proponent of having life cover and in particular, income protection).

 

[Raz]

IMO there should never be a gap with health insurance, it should cover the total cost of a hospital visit.

Quick lesson on how health funds pay your claim for a stay in hospital:

When you're admitted to hospital, there are two types of fees which are raised: the hospital fees and the medical fees.

The hospital fees relate to the use of the actual hospital itself...the bed, operating theatre, ward costs etc...think of it as sort of an accommodation charge. The amount that your fund pays towards these costs depends on what level of cover you have, whether you have any excess on your membership and other variables.

The medical fees relate to the actual procedure you're having; in other words, what your doctor and aneasthetist charge. This side of things is a lot more straight-forward, because assuming it's a non-restricted procedure, your fund will pay the medical fees the same way regardless of what level of hospital cover you have.

First of all, there's something called the Medicare Benefits Schedule. The Medicare Benefits Schedule (MBS) is the list of fees and charges established by the Commonwealth Government for the purpose of paying benefits under the national Medicare Scheme. When you make a medical claim, medicare will generally pay 75% of the MBS fee, and then your health fund pays 25% (this is sometimes referred to as the 25% Gap). What this means is that you're covered for 100% of the MBS fee.

In a perfect world, this would mean your operation actually IS completely covered and you don't have to pay anything yourself for it. In the real world though, you'd be extremely lucky if you found a doctor who doesn't charge anything over the MBS fee for their services. This is why you may find your fund doesn't cover the whole cost of a hospital visit...it's because the doctor has charged you over the MBS fee...