Checking for weasels.

[reynardo]

Now that we're a family unit, lederhosen has suggested that we look at the different types of Health Insurance available, and make a sound decision based on the facts.

For those of you in the US, Australia has Medicare which means you don't have to pay when you go to hospital and for other basic medical needs, but if you want to avoid waiting lists for elective surgery, and you'd like cover for dental, chiro, etc, you have to take out your own insurance. Most workplaces don't include medical insurance as part of the employment.

Knowing that the companies will be trying to reduce costs in any area they can, I read carefully, looking for those parts where they are trying to weasel out. Sure enough, the clauses are myriad.

Even if you're in the top (read - most expensive) cover, the biggest catch is that they will refund only the fees (or part thereof) which they think are appropriate for the service - and most practitioners charge a great deal more.

So quite often you're left paying the gap.

Example - Mrs R. went to hospital for a suspected heart attack. Her fund covered her for 80% of some stuff and 100% of the rest - according to their fees. Accounting was made for each band-aid and paracetamol tablet. After the 10 day stay, the gap between her bill and her cover left her with $4000 to pay. She did get a private room, and the choice of her doctor (who visited her 8 times for about 10 minutes each time, and who went over her results after the hospital doctors and specialists had diagnosed her and prescribed accordingly).

Mrs S. has no health insurance and thus was covered by the Public system for the same heart attack. She was attended by the hospital doctors in the room they felt was appropriate (a 4 bed ward). After 10 days she left, no bills to pay.

Same goes for having a baby. Go private and expect to pay an extra $4000. Go public and you have paid already through your taxes. But go public and you wait forever for the public ob/gyn appointments. On the other hand, most funds don't cover midwives at all, so private practically guarantees you an ob/gyn surgeon, and they seem to be rather fast with the knife and the drugs. (Believe me - I've had both.)

Most funds have what they call "Member Approved Providers" or something similar, who will work for just what the insurance pays back.

However, there are very few in our area. You look up "Dentist" and there's one within a 40 km radius. In the whole of Australia there are NO Ob/Gyns on that list. Which means for any of the extra services you get, you find your own practitioner and pay that gap.

So why have the insurance? Well, the public system is also trying to save money. Their definition of "elective" surgery can include debilitating stuff like hip replacements, and queues of 2 years. If you get cancer, they will try the cheapest drugs on you first, and again you end up sitting in the waiting rooms for ever.

And depending on your area, a private room (or semi-private) may be a blessing.

However, I've seen a friend in the private system ignored while she asked for help post-op because she was bleeding, and only the jump-up-and-down-screaming of another friend avoided what was almost a tragedy. (The post-op lady isn't the sort to make a huge fuss so the nurses didn't think she was that sick). The same lady needed an X-ray on a Saturday night in the private hospital she'd decided to pay extra for, but their X-ray department is only open business hours, so she got wheeled to the emergency section of the next-door public hospital in a fairly rough area and got to spend 5 hours in extreme pain waiting for an X-ray among the pub-fight victims and the drug overdoses. I've been caught myself with ultra-fine-print on a separate page regarding being allowed to accompany someone in hospital (the print said that both the patient and the person accompanying them had to be top-level members of the fund. Only the patient was a top-level member. I was furious.)

So - back to the policies.

Aha - here we go. You pay $2200 a year for maximum cover for a family. And unless you're in an accident or some sort of medical emergency (like appendicitis), you have limits on what you can claim.

Pre-existing conditions have waiting times (fair enough).

So let's say that after a year, we start claiming back the chiro, the dentist, the orthodontist...

Hang on.

Chiro is currently $40 per week, 52 weeks a year. Maximum claim back - $400.

Dentist (preventative) is all ok, but I have a pair of wisdom teeth are going to come out under at least deep sedation. (I'd prefer anesthesia). Expected cost $1500. Maximum refund - $400.

Orthodontist (have you seen Adam's teeth?) Usual sort of cost - around $4000. Per person maximum rebate (lifetime) $2200-$2500 (depending on the fund).

Hmmmm...

And most hospitals stays leave you paying $80 per day (although you get full cover after a certain time, but the fund has to approve this).

Did I say "weaselling"?

I'd like to apologise to the weasels.

Comments

[lordstorm.livejournal.com]

I remember nearly 18 months ago when I had my car accident. I was picked up off the side of the road in a daze, and driven to Glen Innes hospital. The hospital didn't even ask me if I had insurance (well not that I could remember, I was in deep shock at that time), but I couldn't prove it if I was since my wallet was back at the accident scene.

I ended staying there for 3 days in a public ward, but due to the time of year (the accident was late New Years Day 2002) it wasn't at all crowded. I only realised 6 months later I wasn't even presented with a bill: I suspect they found my Medicare card rifling through my identification when the police went through the crash site later, and had charged their expenses to that. I really didn't need any specialist care: mainly a hospital bed for three days, chest X-rays, medicenes and antibiotics for the pneumonia, but later at tax time, sorting through business expenses, I'd realised it must have been Medicare that covered it.

I've thought about going private since, but I'm not that well-off to afford even a decent amount of coverage (I can't even afford ambulance membership), and now having read your research into the area, I'm more disillusioned about it than ever. Maybe I should just stay on Medicare....?

[frou-frou.livejournal.com]

I did all the research a few months back, now that my income has pushed us into the range where we will both be paying the extra $500 pa if we don't have private insurance.

When I read the info I got mad and disillusioned. I resent being bullied into purchasing a high cost product by a private company, especially when it is government policy to do so - I also resent the fact that as someone who is over thirty, I'm charged an extra percentage for each of those years despite the fact that people in their thirties are at their healthiest and least accident prone, therefore least likely to actually claim.

I resent the fact that it will cost me much, much more in the unusual occurence of making a claim, than if I rely on Medicare which will charge me nada.

I resent the fact that private insurance will bite you big time for extra costs if you use an ob/gyn and now due to federal policies a large percentage will be retiring on July 1st so most Melbourne women will have no choice but to go public - in Western Melbourne, for example, there will not be any obstetricians after this financial year due to the insurance crisis (hopefully now averted, but I have yet to hear of doctors reversing their plans).

It will cost me more, but I prefer to support the public system. I believe in all people having access to the medical services they need, regardless of income and the best way to do this is to support the public system. Currently it costs me over $1300 pa to visit the doctor three times a year, and maybe have one or two tests. Money well spent, if it means that those less able can get what they need.