Health insurance comes with a lot of confusing and often unclear questions, that can lead individuals into sticky situations. With insurance premiums about to rise on 1 April, it’s a great time to heed the warnings from the community by conducting a competition, that involves calling out the worst health insurance policies you or someone else has experienced.
Nominate a dodgy or concerning health insurance policy, which could be a bad clause or practice or any other related problem that has left you scratching your head.
The most interesting response will be awarded the Shonky Spotter badge
Not content with increasing our monthly premium from $414.90 to $434.95 last October, an increase of over 4.8%, they had the temerity to email me yesterday to advise that the premium will increase in April to $460.98, an increase of almost 6% in just 6 months.
A few years ago when I had several rounds of treatment by my pain management specialist thus leaving Bupa out of pocket that year, they had the gall to have someone ring me to try to organise a “health care plan” and even asked me if I would stop using sugar in my one cup of coffee each day.
They did the same with my wife’s sister’s husband after he had a double hip replacement.
Neither of us ever heard from them before or after, only when they were not making a profit.
Not a great defender of the health fund providers, but to be fair the funds were ‘encouraged’ by the Government to defer the increases due 1st April last year for six months due to the Pandemic. Like the banks were encouraged to allow mortage repayment deferals.
So the 4.8% increase in premiums was for a year, not six months.
Technically the October increase was a deferred April 2020 increase so on that basis it was an annual increase, yet few could take advantage of any health insurance for most of the year
so why give them a byte on their catch up increase. Bupa has its full amount for 2020, and now for 2021 even though most/many/some of their customers have not been able to use much or even any of it in the interim.
The magic word in the overall plan was deferral, not delaying the increases.
I left the fund couldn’t afford it really and fed up with constant price increases. The only shonk i notice are the funds themselves. I still remember when you could get cover for the whole family. Cant really understand any of the increase.
I cannot understand why Bupa and Medibank Private have the largest numbers of members because they both spend millions of members’ contributions on sponsoring national and international sports; make profits and pay dividends to shareholders. Bupa is a British company so the dividends go to shareholders in the UK.
I keep telling people: Join a non-profit fund!
jacrow - Adelaide
I am 84. Following bad advice from Bupa I joined HCF. Last year I was diagnosed with cancer - Multiple Myeloma. I am being treated at the Icon Cancer Centre at the Wesley Hospital, Brisbane. Wonderful people. I am being treated with Zometa to slow the damage to my bones. After several months of the drug being covered by HCF they suddenly informed my hematologist that they would no longer pay the $150.00 cost per 30 days. I have written a strongly worded letter to HCF and will keep you informed of the result, if any.
Have a look at this site the drug is available as a generic type and Zometa is only one brand name of the product, you may be paying a surcharge for a Brand name product when you have no need to or you may be getting it as a Private Prescription. If it has been issued as a private script, ask to change to a PBS item not a Private Script, this will require the issuing of an Authority Prescription but they do have Streamlined Authorities for this drug. They don’t have to ring the PBS to get an Authority authorisation, I have listed possible Streamlined codes below. As it is then a PBS item the Maximum charge for a general patient is $41.30 (unless there is a Brand surcharge). As this is an Authority Prescription and if on a pension (or other Concession Card eg Commonwealth Seniors Card) or after reaching Safety Net you may find the price drops to $0.00 or about $8.00 depending if a pensioner/Health Care Card holder/Seniors card holder or none of these.
At the PA Hospital Haematology/Oncology clinic this may be free treatment. It may be worth looking into. https://metrosouth.health.qld.gov.au/haematology?provider=66 They also undertake Stem Cell transplants on some patients (the stem cells are collected from the patient to be used in future treatment to replace damaged cells)
There are various Streamlined Authority script reasons for this drug. In your case they are probably one of these possibilities:
9268 Multiple myeloma
5735 Multiple myeloma
Your GP may be able to generate the script for you and you could get it dispensed at your local Chemist (your Haematologist/Oncologist might still give the injection but your GP may be able to as well), again worth checking to see if this is the case.
There are several severe side effects possible with this drug but as you are under care from a Haematologist they should be watching out for these. Generally the drug will only be given for a maximum 3 year period.
I am not a Doctor so please ensure you get good advice from a Licenced Medical Practioner to ensure you get the right/correct information. Your GP should be the best starting point.
Without researching your policy, it is common for funds to have annual caps on non-PBS scripts when they are covered at all (usually in extras), if that is what has happened. @grahroll’s post suggests possible solutions.
Each state and then each fund can have differences, but in Victoria my previous (GMHBA) and current fund (HCI) both reimburse Ambulance Membership at 100%.
and other funds in other states might do the same. Sometimes the only way to know is to ask them. Each roughly $100 membership outlay is ‘recovered’ many times over from just a single ambulance call having to be paid at RRP.
Australian Unity would not give me a definition of “dental”. Apparently they rely on numbers (codes) set up by someone (presumably a Dental or Medical Association.) I had a cyst in my mouth which they claimed was “dental” because my surgeon used a dental code for the operation. I say “dental” relates to teeth not to a cyst (even though it was attached to a tooth.) They refused to pay for the operation (they paid for the hospital after deducting my excess.) Out of pocket by over $1,000.