Queensland , Gold Coast.
Medibank Private Advantage Plus Top Cover
Replace thumb joint with titanium piece
Specialist only operates on arms, hands to shoulder. Had to pay up front Doctor $2715.00, General anesthesia $200.00
Hospital excess $200.00 .Medibank advised they paid $4200.00 for theater and one night stay.
After Medicare and Medibank refunds Out of pocket costs totaled $1700.00
Rds Gary Webb
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âThen there was some serious hard sell from a neurosurgeonâ I thought my contribution was sufficient on unnecessary out of pocket expenses at Private hospitals and specialist consultations - and then this provoked me. I more than reasonably believe that unnecessary back surgery is one of the greatest waster of public funds. Us studies have demonstrated that spinal fusions achieve little in the way of pain relief for the âvictimâ of The Medical Industrial Complex. The four page glossy information sheet from the Neurosurgical Society only claims to provide compression or pressure relief to the spinal vertebrae in the majority of cases, yet no undertaking wrt pain relief. The same disclaimers are provided for laminectomy procedures of varying severity. The newer field of microsurgery, offers less invasive options, yet with higher out of pocket expenses, Evaluation of cost/benefit will come later. I personally attended multiple consultation with multiple of the best and most expensive neurosurgeons, including a Mr. Not being satisfied with their undertakings of what amounted at law to âall care, but no responsibilityâ I consulted a Pain Management Professor, with my MRI and report, who sent a referral to a third neurosurgeon - whose secretary contacted me with an offer of another appointment. The hands of the MI Complex just keep on rubbing together. As soon as you have an investigatory procedure, the best being an MRI, the more likely surgery will be deemed the 'best or preferred outcome for the surgeon.
I submit that managing expectations is the real deal that must be reviewed when surgery is being considered. Being in so much pain that grasping at any straw is the necessary outcome - only enriches the MI Complex. A TV and radio medical personality spruiks for back and spinal surgery. I suspect the Medical Ethics Board might review these conduits.
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Quite some time ago I ended up in a US hospital for a few days. A traveler in the next bed had some malady I do not remember, but it caused him to be admitted. I still remember âsurgeon 1â trying to sell him on surgery there and then, and then bringing in âsurgeon 2â to double down on the sales pitch.
The patient was smart, discharged himself as soon as he was good to go, and his first stop when he got home was to be his GP. Bottom line is that for many practitioners medicine is a business and they operate it as a business.
Want to supersize or have fries with that procedure?
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I am a disability pensioner. I maintain the top level of private health and extras cover but I am finding that when I feel there are going to be a high total of out of pocket expenses I revert to the public system. I just cannot afford the gap payments required by specialists, even including dentists.
I often think about leaving my private insurer but, as I suffer from a mental disorder and could need hospital admission for treatment, I still maintain my membership. At $120/fortnight I definitely donât feel I get my moneyâs worth but I will not go to the psych ward of any local hospitals in the area.
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Hi PJ. Your costs frighten me. After a very expensive mistake on my part, we now hold full private hospital cover; and never again will I let it drop below that level.
BUT ⊠we do NOT have any âextrasâ or âancillaryâ etc. cover. My attitude is that the extra amount charged for that is far too much for what I expect will be minimal benefits for me. So, for example, we pay full costs for all dental work, optical expenses, hearing aids when I get to that stage, chiropodists, etc. I reckon that I probably save a lot each year in this way. I donât want to be subsidising yuppiesâ gym costs and trainer shoe costs etc. (Although I do understand the good logic of the companies in believing that this helps the user to keep fit, well, healthy, etc.)
Now, I have no idea of how this approach might suit your situation; but if you are able to get your head around the variables (I certainly could NOT do so!), it might be able to save you a lot of money each week.
Oh, and if you should find that this approach might help you, be sure to have ALL of your dental and optical etc. work done BEFORE you alter your plan.
Best wishes.
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I encourage you to periodically re-evaluate that. Some private funds have quite generous cover for hearing aids and major dental and when you combine 2 routine dental trips p.a., the inevitable major dental work most of us need sooner and later, hearing aids every 5 or so years, and annual or bi-annual optical products, it can easily be double or triple what some funds extras cost; while other funds could remain in negative territory for most people unless they also take massages, gym memberships, etc.
It pays to shop and especially to look at what extras actually pay for services you will use, and plan ahead for waiting periods.
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For those who havenât seen it, weâve launched a campaign on unexpected medical bills (i.e. out-of-pocket costs). You can take a look here: https://campaigns.choice.com.au/unexpectedbills/
Please sign and share it with anyone who has been hit bit big bills in hospital!
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Signed itâŠ(20 Chars yet?)
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Othodontic is another example - banding costing many thousands and funds giving upward of $1000 per year - itâs usually possible to spread the payments out over a few years to get a better benefit, but not always.
Another trap is moving interstate and completing orthodontic treatment with a new practice - my experience was a 30+% increase in the fees to finish off treatment ⊠just because âthatâs our pricing structureâ ⊠of course there is sometimes no option, and they know this âŠ
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The private health industryâs response to the survey is precious.
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It is almost as if Private Health Insurance was just so companies can make a profit. Am I missing something?
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These guys: https://membersown.com.au/ are supposed to be there for the members - the âaboutâ page is interesting. Iâve had a good run with Defence Health, a Members Own fund - been with them many many years, theyâve always come up better when Iâve compared and not planning on leaving. That said, the difference to me doesnât seem as marked as Iâd have thought when you consider how much cash of the big for-profit funds must go overseas/back to investors.
Itâs my suspicion that the real profit is being made by people much closer to the healthcare service delivery point and Iâve never fully understood how a health fund (or Medicare for that matter) can say an item code costs âxâ when the healthcare provider charges â2xâ or more - it seems incumbent on neither party to justify their position, almost like its a protected racket ⊠maybe I am missing something as well 
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The tables of charges are an attempt to regulate prices through market influence. The theory is once costs become intolerable for the masses prices will stabilise.
The reality is the prices go up and the masses push the table minders to increase the subsidies. The outcome is the disparity between the subsidies and charges continues to widen.
The fear mongers bleat that if there was health care cost controls the medicos would emigrate to countries where they could make their motza and we would be left with an insufficient number of mostly second grade providers. Some would, but I like to believe there remain a number of humans in all walks of life who live for more than their personal wealth.
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⊠sounds almost like uncontrolled escalation ⊠almost âŠ
They are fear mongering by calling them second grade providers as well - I live in a town with an abundance of imported healthcare providers because it seems many of our locally trained people arenât always keen on âthe outback experienceâ and I donât believe there is a problem with them in the slightest âŠ
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Thanks Ray,
I have revisited my cover and looked at HCF, supposedly a not for profit insurer, but their premiums are about the same and they do NOT offer any higher benefits than AHM my current for profit insurer.
The only extras I use are optical as the dentist has priced himself out of my custom. I now attend a public dental hospital run by the Uni of QLD. Only final year students overseen by a professor do my teeth and I have had to have partial upper and lower dentures after cancer mouth surgery. These were provided free and they fit really well. My local dentist quoted nearly $4,000 for the dentures of which I would receive a benefit of $1200.
I am going to get rid of my extras cover after I get some more glasses.
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Hello PJ. Thank you for this reply/feedback.
Sorry that the alternative insurer did not offer better value for you.
My own insurer is a MUTUAL â I trust them much more for not being greedy and money-hungry â but I have no idea as to comparability of costs and benefits with them. I have been with this organisation for about the past 15-20 years, and before that with the other mutual which it bought out for about 35 years before that. I have written in here under the Health Insurance subject on how happy I am with my current insurer â Australian Unity.
I donât know if it might be an interesting exercise for you to investigate their costs and benefits, so that when it comes time to renew yours, it MIGHT prove a better option, maybe.
I was not aware that it is possible to pay extra only for Optical cover. That is a good move. My OLD understanding was that there was just âextrasâ cover (by whatever name) to cover everything else.
Queensland Dental Hospital: wow! That is indeed a wonderful service for you. Once again those who do not live in cities do not have easy or cheap access to such services, needing to travel huge distances to get there, and then for accommodation and food and drinks en-route and whilst in the city too.
Again, I thank you for your reply.
Wishing you all the best.
Ray.
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Iâm with HBF in WA and itâs a massive headache trying to understand âout of pocket costsâ. I tried to get a quote/confirmation of costs from HBF just last week for a small day procedure. The surgeon and anesthetist are both HBF memberâs choice providers, and the hospital is a members choice hospital. HBF said they couldnât provide any assurance or confirmation unless I chased the specialist and surgeon and obtained the item numbers and charge amounts for the procedure.
The specialist secretary was very rude when I asked, demanding to know why I was wasting her time asking for those details as I didnât need to know, and as they were members choice HBF cover it anyway. When I explained HBF told me it was a requirement she just huffed, went off and got the info and then told me to not bother calling back again as thatâs all she could give me.
The anesthetist secretary was not rude, but also said she couldnât understand why HBF needed the info. She then gave it to me, and said that it could be one of three item numbers depending on different factors.
I relayed this back to HBF who eventually sent me a letter that said I was covered with no co payment, but then listed 14 disclaimer bullet points about what I could be charged anyway. I tried to get clarification from HBF, the specialist and the hospital about what I could expect and they all said âwe canât tell you, it depends on what happensâ.
They then force you to sign a disclosure saying youâre aware of the potential charges, even though they canât clarify them.And when I mentioned this, the response was âyou either sign it or donât have the procedureâ, and no we canât give you an estimate.
So I still have no real idea of what my out of pocket will be, other than I have no excess to pay and i donât have to pay a co-payment for the room.
The system is broken and run by arrogant specialists and hospitals.
It was a similar situation when I had some issues in 2016 that resulted in 3 hospital stays over 4 months. Nobody would ever tell you what to expect, and I had to keep signing documents stating I was informed about potential costs, where the only informing was âyou might have all of these costs, or none of them. We canât tell you if any apply, and we canât tell you how much they might beâ. I ended up spending the next 6 months paying bills that trickled in for misc things, none were massive but it probably ended up adding up to around $800.
Itâs the lack of ability to get estimates that really gets me.
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I can strongly relate to your frustrations, as outlined. Thank you for sharing them. I am sorry that I have no strategy to offer in order to get around those obstacles. And I must say that the responses from the specialistsâ reception staff are disgusting. I spent most of my working life in customer service roles; and what you have experienced is not good customer service at all. Best Wishes for a successful outcome â both medically and economically.
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This topic is getting increased public attention.
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Thanks for sharing the detailed and no doubt highly frustrating experience. CHOICE is listening to consumers on this issue and Iâve shared your story with some of my colleagues who are working in this area.
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