CHOICE membership

Health Insurance and choice of doctor


#1

I have a mental illness which has required me to have ECT frequently. I do have top health insurance cover. I do see a private specialist fortnightly and have not required to be an inpatient for over 5 years. However although my specialist I see in private practice, he does not work in a private hospital but rather is a consultant in a public hospital, this was previously not a problem because if I did need hospitalisation I would enter as a public patient at the hospital that he works at. However, now he has been told that he can only admit patients who live within that hospitals area of care, and unfortunately I don’t live in that area. I’m on a pension and am generally healthy otherwise so I cannot really afford to pay for top hospital insurance when my specialist works in a public hospital but has been told that he is not allowed to admit there, even though I have seen him since before 2006. What would you recommend?

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#2

Have you checked with your health insurer as the hospital catchment limitation seems a little odd…as you may be able to enter as a private patient in the public hospital, rather than a public patient?

You can ask them if his services in the hospital he works is covered by your policy.

I wonder if the restriction is from the public health system (State government health department) rather than that of your private health insurer.


#3

I do actually believe that it may be the fault of the state health department rules, but surely they must realise that they will not be paying more for me to see the doctor who knows my case history and what has and hasn’t worked before, remember that for a psychiatric admission to a public hospital in my state each day of a patients admission costs at least $1400/ day, so I think that it would be obvious that the doctor who already has my background and history will not have me admitted for longer than it would take a doctor who may have to begin from the beginning again, I should add that I have opted out of the Health Record system because of my own privacy concerns. I believe that the hospital is paid more by the public system than the private insurance is prepared to pay, so they want you to go in as a public patient, so I don’t think that they want him to admit his private patients. It just seems that the administrations of the public hospitals in my state just can’t use what I believe is plain commonsense!


#4

It does seem odd especially as almost all public hospitals where I live are constantly criticised by patients for trying to brow-beat them into using private health cover (because they get more money that way) even if they turn up in emergency with say a broken bone. Often the only way to stop the administrator questioning you is to tell them you dropped any previous insurance they have on record! I have not heard of ‘catchment areas’ similar to school catchment areas I suppose, although I did hear of moves to prevent people without medicare cards accessing things such as screening tests for free e.g. overseas relatives of Australian residents.

Under your top cover private health insurance you are usually permitted to choose your own Doctor. So I would advise you to contact them and ask whether they have an agreement with that hospital for the services you might require. Then make your decision about whether to stay with that insurer or try to change to another. Keep in mind things may change from 1 April this year!


#5

In Brisbane they certainly have sort of these, just to name a couple West Moreton Health Hub (Ipswich and areas) and the Metro South Hub (which covers the areas serviced by the PA Hospital, QE II and I’m not sure of their others). If you are already an existing out of area patient they normally continue your out patients treatments but new referrals are and can be declined and the patient is referred to their Dr to get a new referral to an covering hub.


#6

my private psych was a fly in/fly out and admitted at the other end of the state. I was deemed not able to travel alone and change planes. However, I was not allowed air ambulance by this psych or GP which meant travel alone and change planes in Sydney!!! Yes I got assist on the planes on & off, but got lost at Canberra airport and left to roam Sydney after being pointed to where the next plane would be. Funds will not cover attendant. Medications over and above those listed were not covered by fund. I paid top plus. Why???