Help Needed Please - Tonsils Private Surgery Cost Is Very High and Public Wait Time Is Nearly 12 Months

My child needs removal of tonsils, adenoid and middle ear fluid.

We don't have private health insurance and cost of getting it done private is $5600 after medicare rebate. The cost is as follow:

1) ENT Specialist $1400 after rebate. I would have to borrow personal loan of $5600 because cannot afford it.
2) Hospital $3700
3) Anaesthetic $500

ENT specialist operates in Nepean and Westmead hospital where he advised the waiting time on public list could be more than 12 months. He said he could push for 1 month out of 12 months so effectively 11 months wait. Is this how it works?

Is there anyway to get it done cheaper or get it done via hospital with less waiting time(don't know how to find waiting times)?

Many thanks in advance.

Comments

  • At least in Queensland the wait time in public hospitals is determined by urgency:
    https://www.qld.gov.au/health/services/hospital-care/waiting…

    What state?

  • That sucks, hopefully the wait list isn’t too long, is the $3700 for one night?

    • $3700 includes overnight stay, theatre and prothesis fee.

      • +29

        Go to India and do it. Probably cost $2000 including travel.

        • +3

          Don't know why you got negative votes, I think you needed to be a bit more elaborate.

          That there are options available which are safe and not super expensive.

        • +7

          Not the silliest idea. I spent two weeks in Delhi in the ICU after falling ill in Nepal. Total cost was just over $2000 USD. Highly trained medical staff. High ratio of staff per bed. In a pinch there could be worse options.

          While on the ward before discharge I met a heap of medical tourists who were there for various treatments. Including an aussie getting a shoulder reconstruction.

        • +7

          More than that. Remember the kid won't be travelling alone. So 2 airfare = approx $3000, operation = $500, accomodation = $500, food = $200.
          These are just rough estimates.

        • @rooh:Suggest you get a quote from BIH

          https://en.wikipedia.org/wiki/Bumrungrad_International_Hospi…

          Get it done on your next holiday, and make it a procedure your kid can enjoy.

          And whilst you are at it, get anything else done that is too damn expensive here in Oz!

        • +1

          And equally good or better doctors in India if you go to bigger city and reputed hospital (go for any large one!).

        • Do it in Singapore. Its closer and serviced by lots of airlines - cheaper flights. In general they have higher medical standards than India but cost a bit more.

        • @pig:

          In general they have higher medical standards than India but cost a bit more.

          A lot of doctors in Singapore are products of Indian medical schools. You can't see 'average' when you look for anything in India. You need to see their 'above average' or 'the best' and that is easily accessible without 'wait time'. I doubt if that would be any inferior to that of Singapore if not better. India has got some of the best surgeons in the world in various fields.

        • @virhlpool:
          I said medical standards - not doctors.
          Medical standards is more than just doctors/surgeons.

          In India, anyone can open a dental clinic without any training/license and no one will stop you. A lot of hospitals in India hiring untrained nurses and they are being paid peanuts. Basically, almost nothing is strictly enforced. Doctors can get away doing a botched job multiple times without much repercussion. Patient that are advised to take special insurance to cover malpractice.

          Singapore, on the other hand, is very regulated and they have effective system to enforce their rules and regulations.
          This is what makes the standard higher than India.

        • -2

          I've got a mate Darshit who'll do it for $200.00, all expenses paid.
          No problem.

        • @pig: Totally agree. On a separate note, what we need is the best of both - medical standards and quality doctors. We probably have higher medical standards but I am not sure if that reflects on the quality of GPs that we come across in Aus. If you ever get a chance, compare our GPs to that of India or Singapore and you will see the different right away. I can say that because I have lived in those places. Not really sure if it has to do with their more rigorous education system or their GPs seeing far more and diverse patients everyday (due to much higher population and varied health/social profile of people), or just the higher IQ in science, again due to the rigor of their overall education system including medical.

          I can't comment much on specialists as I haven't had to dealt with any so far.

        • @virhlpool:
          The next time you go the GPs you reckon do not reflect the Australian medical standards, take note of where they graduated from.

          Due to some bizarre agenda, the government extended our medical licenses to applicants from other countries. There was a huge influx of doctors from India and many of them attempt to hide their training origins by detailing where they got their Australian lisence rather than where they were trained.

        • +1

          @virhlpool:
          This has nothing to do with education or IQ level.

          GP in developing world is pushed to make a decision in 1 visit. They are most likely paid directly from the patient pocket and patient won't come back if they are not getting anything from their visit. The majority of their patient genuinely sick rather than taking sickies. If the patient comes back for the second or third time then they'll refer you to a specialist and they have no hesitation when referring to specialist as it was treated as referring a business to the specialist.
          Doctor in developing world hold some kind of higher status and when they are lucky enough to correctly guess a symptom they are percieved to be better.

          GP here operate in very defensive mode where they are very careful with their advice.
          They will lay out the possibilities but generally won't come to any conclusion. Its very common for them to give you MC and ask you to take a rest. If the symptom is serious enough they'll ask you to do more research ( ie blood samples, xray, etc ). They seem a bit hesitant to refer patients to a specialist.

        • @pig:

          They seem a bit hesitant to refer patients to a specialist.

          Why is that though? Is it due to long wait time / queue for specialists appointment in public system? Or just because they aren't getting any business benefit by doing so (particularly when they refer the patients to public system specialists)?

          GP here operate in very defensive mode where they are very careful with their advice.

          Lack of advice AND lack of diagnosis skills (may be due to lack of experience of seeing a huge volume of patients) are two different scenarios though.

        • @simgue:

          I’m confused.

          Did you have travel insurance?

        • @Eeples: I did. Took me about 3 months to get it reimbursed upon return to Australia. Cost was irrespective of insurance or not.

  • +16

    Wait times in NSW and everywhere else is determined by urgency.

    Is your child unwell at present. Can he eat and drink without problems, does he have ongoing pain? How many episodes of tonsilitis has he had? I guess what i am asking is - why do you want to get it done urgently? It may he fine to wait 12 months.

    If you have ongoing problems, I would suggest seeing your doctor again so they may be able to book your op in sooner. If your doctor can book it in 1 month that seems reasonable. I wouldnt get into debt to pay for surgery if the 1 month option is feasible. Tonsilitis causes pain, and it is horrible for a parent, but is rarely life threatening.

    • His eating has significantly reduced over last few months. He is delayed in speech, tends to speak via nose, snores heavily and we are seeing heavy cough attack whenever he wakes for last 2 days.

      We saw ENT specialist on on Friday after 3 months wait and it was shock to hear about private surgery price and public wait times.

      I am not sure what can I do to put him into category 1? Seriously last 2 days morning choking gave me worst feelings parents could get.

      • +29

        You need to make sure that your ENT specialist knows about the worsening symptoms and your concerns. They maybe not be aware.

        Also, have you tried asking a different ENT specialist? Most specialist are careing people but some care more about money so they try to divert you to their own private practice. Prices in private also vary considerably.

        If you are really concerned, take your kid to Emergency.

        • He is chocking whenever he wakes up or run for 5 minutes for last couple of days. Had to rush him to emergency yesterday where they confirmed that he had red large tonsils but they want him to go through his ENT and were not ready to do urgent intervention.

          I have flagged issues with ENT and waiting for his response re what category he is planning to put him in public waiting list.

          If he still don't consider him putting into at least Category 2, I will consider discussing it with another ENT.

        • +6

          @Sshanaz: He has sleep apnoea and developmental delay. I'm surprised you were told the wait is that long.

        • +2

          @Sshanaz:
          If you're showing up at emergency often, and its bad enough, they might just do it as an emergency procedure then and there if they have the space. Thats what happened when my wife needed a procedure, but we had BUPA so we were able to get a specialist into the hospital to do it the next day.

        • @stumo: this. Sometimes it’s easier for all the medical staff too if they can just get the Okay and the room one.

        • @Sshanaz: hey why don't you get a loan?? No savings of 5k??? You gotta do something , honestly how come you have no savings ?? Perhaps evaluate cash flow /lifestyle decisions? Good luck for you and your child

      • +23

        Category 1 is usually reserved for head and neck cancers and tonsils that at risk of obstructing the airway.
        Specialists and theatres decide what's category 1 unfortunately. Not how distressed parents are.

      • Flight to India and get this done overseas.

        This is the problem, by giving free gp visits not enough money left for more serious stuff .

        Hope it gets sorted man

        • -4

          That seems silly.

          I'm sure the specialists know what they are doing, and the risk of getting it done in some dodgy overseas hospital far outweighs the risks in following the doctors instructions

        • +2

          @Pacify:

          Just because the kid will breathe easy faster?

          A simple Google search lands to this page

          http://www.gnhhospitals.com/dr-suresh-vatsyayann-most-experi…

          The surgeon is trained in NZ and is a Fellow of Royal New Zealand College of General Practitioners in 2004.

          I don't understand why preconceived notions are always found with blood of pragmatism on their hands.

          The guy gave an option so that kid will be out of pain well within a week.

          I won't like my kid to be waiting and suffering for 12 months whilst there are options available, no harm in using the option if there are no negatives attached to it.

        • +2

          @Curiouscat:

          Medical tourism is definitely something that has possible negatives attached to it

        • @Pacify:

          'Dodgy' GPs here OR overseas hospitals? Both exist - you just need to be vigilant.

        • @virhlpool:

          Sure, but comparing specialists here with flying to India to get it done is on different levels of risk. People really underestimate the risk of medical tourism

        • +2

          @Curiouscat:
          he's a bloody GP, not an ENT specialist.
          this is entirely the reason to stay within an appropriately regulated medical environment.
          i'd not let him near my child.

        • -1

          @mkerr:

          As I had mentioned it was a simple Google search which fetched the result. I am sure just like me if you were in OP's shoes trying to help your child by getting surgery done ASAP you would have found a qualified ENT as well.

        • -1

          @Curiouscat:
          you seemed to think that the results of your search justified it as a viable / reasonable alternative, which is isn't.
          it's one of the dangers of medical opinions from unqualified people.
          i'm not in OPs shoes. i know what deserves a cat 1 referral and what doesn't.

        • -2

          @mkerr:

          Nope mate, I just wanted to say given the situation family us in there could be something overseas which will help them to get out of the situation.

          Only if they want to.

          Not trying to prove anyone wrong,TA.

        • @Pacify:

          Don't take it as 'tourism'. You aren't going to Thailand where every other patient is a tourist patient. In India, you may be one in hundred. So the doc who is treating remaining 99 patients, will treat you will equal quality and precision as long as you went to a reputed hospital/ doc.

      • Try gofund me if you don't have the money, otherwise give me your Paypal address and I will donate some money to you.

  • +9

    From your post it seems like the ENT specialist has said he can push to get the op done in a PUBLIC hospital in 1 month…go for that!

    • Sorry I mean to say he could maximum push it to reduce time by 1 month from 12 months wait time.

      I don't know whether he is fully appreciating the consequences this matter is having on my son's well being.

      • +3

        Sorry just to clarify, are you saying the minimum waiting time your specialist can get for you is 11 months? I also read it as 1 month from your original post. To me that's a huge difference; 11 months sounds much too long to wait considering how sick your child is.

        Can you call the specialist to explain about your child choking the last 2 mornings to see if he can reduce the waiting time further? It might make him more concerned knowing your child's condition is deteriorating.

        • +2

          Going to have chat with specialist tomorrow.

        • +1

          @Sshanaz: Best of luck with the call. I agree that 11 months is too long for your child to wait so I hope they also agree!

          If not, is there family you could ask to borrow the money from? Personal loans have very high interest rates. You may need to do up a budget and find places to cut costs so you can get it paid off asap if you go down that road.

        • @Kail: thanks and I am already checking with friends.

      • +1

        Are you sure there wasn't just miscommunication between you and the ENT? like did the ENT say 11 months specifically or did he mention 1 month in a sentence that could be misconstrued?

    • And push their child further down the list?

  • +32

    its a rip off, but hey that is what private health insurance is for.
    If everyone was able to get the procedure done in public hospital where you want, when you want, for free/cheap, what is the point of private health insurance?

    PS: Not saying private health is cheap, it is bloody damn expensive, but there needs to be some incentive for people to take it up

    • +49

      imagine how good our public system could be if the amount we all spent on private health went to that instead.

      • +17

        The private healthcare part of our system is a complete joke. Its not doing what it was designed to do, at this point its just a giant waste of money

    • +5

      But not sure if even private insurance would cover it fully. If one has to pay $1000 out of pocket after paying $250 every month for years for a private insurance, I see it as a no better option.

    • Except my surgery was like $6000 and I had to pay $3000 odd out of pocket.

      The only thing it covered properly was the hospital.

      Surgeon has $400 cover, costs $1500.
      Anesthetist has $250 cover, costs $900 etc

      Even if we had 'gap protection' it's only 120% of medicare scheduled rates. No good when everyone charges 300% more.

    • Yep, we have top cover and it's expensive as hell. It's overpriced, completely unfair, poorly managed but came in handy when my son needed his tonsils out and also when he was born and needed 48 hours in special care in a private hospital.

  • Hi,

    In you earlier post in May, 2017, How Do Health Insurance Annual Limits Work?
    https://www.ozbargain.com.au/node/306612 you mentioned you were with Medibank (Private?).

    Doesn't your Cover extend to your child?
    Or do you only have Extras?

    • Unfortunately only Extras. I would have to wait 12 months even I opt for hospital cover as it's existing condition :(

      • +4

        Will you get insurance now?

      • +5

        Surely hospital coverage is far more important than extras coverage. If I couldn't afford both I would be opting for just hospital. I can't believe anyone would prioritise extras over hospital cover.

    • +36

      And a heck of a lot less effective.

      Iridology? Look into my eyes. Seriously, if anyone wants to dabble in pseudoscience that's their prerogative. But inflicting it on others, particularly dependants, is just irresponsible.

        • +44

          Peddling false hope is worse than doing nothing at all. Paying for it is illogical.

        • +3

          @thevofa:
          Well said.

    • +6

      I'd rather have a pipe flush water up my ass.

      • Considering how disgusting their medicines taste, so would I! There's a reason I always go to my doctor as first port of call. I'm lucky to have never had tonsilitis myself. My brother had it really bad as a kid, but the doctor didn't want to take them out because he had a kid die on the operating table while having tonsils removed. I'd like to think it's a less risky procedure nowadays, but apparently rather costly if one doesn't have health insurance. This is why people need to stash away savings for a rainy day. Emergency funds are not luxuries when you have an emergency.

    • +2

      This is the kind of advice that would land you in prison should OP's child died of an airway obstruction.

    • +1

      Have you tried homoeopathy !

      Just kidding. Take you kid to the doctor, or even to ER when choking. It is our duty of parents to run down doors if needed.

    • -1

      Except that this isn't tonsilitis. This is an airway with chronic obstruction that will totally obstruct in time and wont ever shrink back down without surgical removal.

      I really hope you have good medicolegal insurance because offering advice like that on a public forum sets you up for a huge litigation risk should someone take your advice and they experience a complication or worse because of it.

      • +3

        Too bad you can't sue someone on an Internet forum… facepalm

        • You can and it's been done.

        • Get a grip, i think they were just suggesting to go that route WHILST waiting for the op.

    • +3

      If the naturopath fails, try a voodoo doll, a witch doctor, or prayer.

  • +5

    Why don't you have proper health insurance? What if it was something serious that needed next day surgery?

    Talk to your doctor tomorrow but you'll probably find they can't push actually seriously sick kids out of the way so yours can have surgery.

    I'm not a parent but if my kid needed surgery I'd make sure they got it. If I couldn't afford surgery upfront then I'd make sure I had health insurance that meant I could get the surgery done. If I couldn't afford that then I'd question whether I could really afford a child.

    Do you have savings of any kind? Do your parents or any close family have money ? I would avoid asking friends because that can get messy if you can't pay them back.

    Look for a personal loan. Perhaps the hospital can provide a recommendation on a provider that helps people in your situation.

    • +32

      What if it was something serious that needed next day surgery?

      Because if it was something serious, he'd be seen in the public system much sooner.

    • +18

      "Look for a personal loan."
      We're all slowly being forced down the path of USA style healthcare

      • +1

        I disagree with this. We aren’t. Medicare is designed to provide the bare minimum in health care. You can get the operation through the public system but your son will have to wait. What exactly are you suggesting is done ?

        Medicare will cover most things but not everything. If you want it to provide more then we’ll be paying more taxes.

        • +6

          I'd be happy to pay more taxes if that prevents children from suffering for months.

        • +2

          @MrTweek:

          Public wait lists for health can never be fully emptied.

          If the wait time is very low, many people will jump on the list for surgeries of marginal benefit.

          If the wait time is very high , patients will seek other options (private , overseas ).

          The public wait time regresses to the 'middle'.

        • +6

          @Yttrium:

          I don't think people would get their tonsils removed just because the waiting list is short.

          The list doesn't have to be entirely empty either, but whether I wait 12 months or 2 months is a massive difference, especially when I'm in pain and can't afford private or overseas treatment.

          I'm on a waiting list in Victoria as category 2, which means I should not wait for than 90 days.
          It's been over a year now and still no word of how much longer it will take.
          Nothing critical luckily.

        • +3

          Medicare is designed to provide the bare minimum in health care.

          Like what? 8-10 hours average waiting time in an emergency ward? Silly GPs who have made the system a joke? Months long wait time to see specialists? Months long wait time for basic procedures? What's that 'bare minimum' in health care?

        • +2

          @MrTweek:

          Why don't rather explore other options to optimise medical costs of hospitals (including wages)? Why not produce more doctors in our med schools? Why not avoid maintaining shortage of nurses and doctors and thereby having to pay them super high premiums? Why not invent some innovative ambulance solutions so that we don't pay $1000 for a single ambulance call which isn't even covered by Medicare (despite yours and mine high taxes and ever deteriorating social welfare)?

        • @virhlpool:
          Yeah, that would probably help.

          But since I have worked for various government organisations I've lost all hope that anything run by the government will ever be efficient :(

        • +1

          +1 Our system is far better than the US one. Even if you pay, it is partly subsidized.

          In Australia, if you had an intracerebral hemorrhage after a bad car crash, you get treated for free through the public system incl. physio.

          If you went through the US, surgery and a stay of around 10 days can set you back approx $250,000+

        • -2

          @Serapis:

          If you went through the US, surgery and a stay of around 10 days can set you back approx $250,000+

          You are assuming that the person wouldn't have insurance in the US but almost everyone in the US has private insurance (in most cases it's partly or fully sponsored by employers) and it's far cheaper.

        • @virhlpool:

          Here are the stats from the CDC:

          Number of persons under age 65 uninsured at the time of interview: 28.2 million
          Percent of persons under age 65 uninsured at the time of interview: 10.4%
          Percent of children under age 18 uninsured at the time of interview: 5.1%
          Percent of adults aged 18-64 uninsured at the time of interview: 12.4%

          This is a far cry from almost. Would be set to rise again if Trump gets rid of the ACA.

        • -1

          @Serapis:

          Look at the % of uninsured people yourself. 10% is tiny compared to 90% that are insured for example. More importantly, insurance is quite cheaper there and often employer sponsored.

        • @virhlpool: 28 million is not a small number, it's like more than the entire Australian population. For à developed country that number in absolute or relative terms is not acceptable.

        • +1

          @virhlpool: Each person that can't afford insurance is an actual living, breathing human with a life of his own. It shouldn't matter what proportion are covered - nobody should have to go bankrupt to pay for lifesaving medical treatment, or die of something preventable because they couldn't afford to treat it.

        • -1

          @Quantumcat: Very noble thought indeed but reality is different in every country, including ours. A lot of us get bankrupt for many reasons - including housing unaffordability, exorbitant cost of living and at times medical treatment cost in private system as the queues in public systems are too long. Your thought is great for society, but by that no one should ever go bankrupt in life for all these silly reasons as well and many others. Unfortunately, that doesn't happen and people do go bankrupt for many reasons even in our country, medical being one of them. I wish your very thought was actually true.

        • +1

          @virhlpool: Actually this does NOT happen in our country, because we have Medicare. If someone needs a treatment to stay alive, it would be covered by Medicare. They won't die in the queue. They will NEVER have to go bankrupt to pay for lifesaving treatment. You've got it completely wrong.

        • -1

          @Quantumcat:

          I am well aware of the intention of Medicare. I don't doubt it even a bit. But the public system has budget constraints and its own challenges. In some cases, it can't help but has to give up. 8-12 hrs wait time in emergency ward (this isn't rare) and 12-18 months long queues for some procedures or to even see specialists (this very thread is about it) are prime examples. $1000 ambulance fees is another, and there are many others which can either get a person go nearly bankrupt (due to being forced to use private system) or suffer from illness for long without getting cured sooner at best. I am not saying the system is totally broken but it's also not as good as you are making it look like. You can't just go on praising something without realizing its serious weaknesses. If it was as great and nearly perfect, there won't be this thread discussing the topic. Happy to be corrected if I am wrong.

        • +1

          @virhlpool: no one is ever going to be charged $50,000 for life saving treatment under Medicare though

    • +6

      Also, if it was something really serious, I wouldn't be questioning taking a personal loan (of any sum) just to get medical treatment.

  • I know what you are going through (our 7yr old is now on his 3rd set of grommets), except that we do have private health insurance. It's so hard when the wait period is that long. Is there any chance that other hospitals have shorter waiting periods (you may have to make a few phone calls)? I.e Can you go to a different ENT and get in sooner at a different hospital?
    How old is your child? It could be worth investing in a higher health insurance for future.

  • +1

    When I was a kid, the wait from diagnosis was about 7 days

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