Bupa Visitor Plus Cover Not Paying Full Hospital Cost for Overseas Visitor. - Advice Needed

destination on 14/03/2019 - 16:29
Last edited 14/03/2019 - 16:44 by 1 other user

HI,

Just need advice on this if someone have gone thru with the similar situation. Please I am just asking for advice only.

So my Mom came to Australia as a visitor so we took out a Visitor Plus Cover from Bupa. Last month my Mom got sick and have to admit in a hospital for Influenza. It was Friday and she stays in a hospital till Monday and got Discharged. On the day she went to hospital the doctors did CT scan and few other scans. We called Bupa and Bupa doesn't want to speak with us as we were not authorised and want to speak with the Patient. They asked us to send a letter which we did and it took them till Tuesday to get back to us. At that time hospital told us that as we have a Visitor cover so no need to pay anything. Now after a month Hospital sends us an invoice of nearly $4000 and when we call hospital they told us that Bupa didn't pay that's why they have send us a invoice.

We then called Bupa and they asked us to send all the documents which we send them and after few days they deposited $800 in our account and told us that they can only pay that much only.

When we took out the cover the cover says that full hospital cost will be covered but now they were saying they can't cover everything and rest we need to pay. We took out the cover just be be safe from like this situation.

So just need advice from anyone who have went thru this type of situation and how to handle this. Do we need to Pay this or Bupa will be responsible.

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Comments

  • spackbace on 14/03/2019 - 16:32
    +7

    What does your pds say?

  • HighAndDry on 14/03/2019 - 16:38
    +7

    When we took out the cover the cover says that full hospital cost

    What exactly does it say it covers? Because to my knowledge, "hospital cost" generally means "hospital stay" costs, but that can be (almost always is) separate and different from:

    CTscan and few other scans.

    Does your BUPA cover include these?

    • destination on 14/03/2019 - 16:41

      Yes when we took out the cover it shows that all the scans will be covered.

      • HighAndDry on 14/03/2019 - 16:45
        +3

        Per whooah above, is this the cover you took out?

        https://www.bupa.com.au/staticfiles/HealthInsurance/Forms/Pr…

        It does say:

        Most inpatient or outpatient diagnostic tests recognised by Medicare as medically necessary (e.g. pathology, radiology).
         What's not covered
        If your doctor or specialist charges more than the above benefit there will be a ‘gap’ for you to pay.

        Could this be it?

        • destination on 14/03/2019 - 16:50

          I have checked on the MBS for one of the scan which is $550 and hospital charged us $1650 for it in the public hospital.

          • HighAndDry on 14/03/2019 - 16:59
            +1

            @destination: Unfortunately that's the "gap". Your issue is with the hospital, not BUPA. However, generally people have good results when trying to negotiate with hospitals - though the fact that your mother is an overseas visitor (and so not a PR or citizen) might work against that.

            • destination on 14/03/2019 - 17:03

              @HighAndDry: I went to the hospital and the admin says that they only sends the invoice which radiology department send to them and ask us to speak someone in radiology but in radiology department told us to go and speak with admin. How can Public hospital charge 200% more than in MBS.

              • HighAndDry on 14/03/2019 - 17:08
                +4

                @destination:

                How can Public hospital charge 200% more than in MBS.

                They can charge however much they want. But yeah - go talk to the admin and say: "We can't pay this much, what now?" The ball's then in their court. Usually they'll try to work out something (discount, payment plan, etc) rather than sending you straight to debt collectors.

              • godoftoast on 16/03/2019 - 16:15
                +1

                @destination: The MBS is a schedule of what the federal government will pay for certain procedures. This price does not factor in the actual cost of running that procedure and is not indexed with inflation. Hospitals are state run. For public procedures the state government allocates extra money on top of the MBS rate to actually run the service. Depending on the location of the service the costs can vary massively. Your parents are private patients and the public hospital can charge whatever gap they want. The finance admin would have let you know exactly how much you would have to pay whilst you were in hospital. If it is something you cannot handle you can definitely call the hospital finance people and negotiate down the price.

        • TrevBargn on 16/03/2019 - 15:04
          +3

          This is something most learn after using a medical specialist. There is a "gap" and your health fund will rarely cover more than 50% of what the specialists charge.

          Medical specialists in Australia are the top earners according to the ATO. Just take a look at the ATO top 20 earners last year:
          1. Neurosurgeon $577,674
          2. Ophthalmologist $552,947
          3. Cardiologist $453,253
          4. Plastic and reconstructive surgeon $448,530
          5. Gynaecologist; obstetrician $446,507
          6. Otorhinolaryngologist $445,939
          7. Orthopedic surgeon $439,629
          8. Urologist $433,792
          9. Vascular surgeon $417,524
          10. Gastroenterologist $415,192
          11. Diagnostic and interventional radiologist $386,003
          12. Dermatologist $383,880
          13. Judge — law $381,323
          14. Anaesthetist $370,492
          15. Cardiothoracic surgeon $358,043
          16. Surgeon — general $357,996
          17. Specialist physicians — other $344,860
          18. Radiation oncologist $336,994
          19. Medical oncologist $322,178
          20. Securities and finance dealer $320,452

          Yes, they studied for a long time, but the Australian medical colleges work hard to restrict numbers of specialists to keep their fees very high. They restrict the number of doctors, even though population is growing and aging.

          • Amaris on 16/03/2019 - 15:28
            +1

            @TrevBargn: More doctors than ever are coming out of medical schools now. In fact, the number of intern positions that Australian metropolitan hospitals can support is fast becoming the bottleneck now.
            As for specialist colleges, they do restrict the numbers getting into training programmes, especially in surgical specialities. It may seem that they do this so that the current specialists get more money. The official (and a very plausible) explanation is that they have to restrict numbers in order to make sure the training each accredited trainee receives in satisfactory.

            • godoftoast on 16/03/2019 - 15:36

              @Amaris: The 'official' reason is correct. To become a specialist of any discipline means one must engage in an apprenticeship program under the tutelage of a particular college. During your time there you must see a certain number of cases/complete a certain number of terms and pass exams before you are qualified to be a specialist. There is no way to fast track this without compromising safety. If you want a fully trained neurosurgeon they need to spend x amount of hours operating under supervision from another specialist and see x number of cases. You cant just magically increase the number of head trauma cases going to theatre or magically increase the number of qualified supervisors that can oversee the trainee.

              • Amaris on 16/03/2019 - 15:39

                @godoftoast: I completely agree that the official reason is correct. However, as a member of the profession myself, I know there's a bit of the other reason as well….espcially when it comes to increasing services in the public sector which is of course free.

          • Amaris on 16/03/2019 - 15:39

            @TrevBargn: As for the gap….health funds don't cover specialist consultations of hospital inpatients. This is covered by Medicare only unless the specialist participates in a no-gap or known gap scheme of the particular fund. Health funds are prevented from covering outpatient GP visits or Medical Specialist visits. When the patient calls the doctor's rooms to book an appointment, they're usually told what the total charge is likely to be and what's going to be given back by Medicare. The gap is not something you learn of 'after' using a specialist

  • Hellfire on 14/03/2019 - 16:40

    Did you go to a public or private hospital?

    • GG57 on 14/03/2019 - 16:41

      Or a public hospital as a privately-insured patient?

    • destination on 14/03/2019 - 16:42

      We went to GP first and GP asked to take her to the Emergency so we took her to Public Hospital which is nearby.

      • Hellfire on 14/03/2019 - 16:45
        +3

        You'll need a detailed response from Bupa on what they are covering against each item that your mum was charged.

  • qwerty on 14/03/2019 - 16:45
    +2

    I would get your mother to call and have them explain why they only gave $800 - it could be restrictions or something else

    alternative is to contact an ombudsman http://www.ombudsman.gov.au/How-we-can-help/private-health-i…

    • Hellfire on 14/03/2019 - 16:47
      +4

      The ombudsman will send them back to BUPA if they don't try to resolve it with them first.

    • destination on 14/03/2019 - 16:47
      +1

      Actually they told us that hospital is charging too much for the scans than in MBS so they can't pay.

      • Hellfire on 14/03/2019 - 16:50

        BUPA only cover the MBS so that will be the reason. It's clear in the PDS (although probably difficult to understand if you are from overseas). You don't have a complaint against BUPA. Try the hospital.

        • destination on 14/03/2019 - 17:00

          Can hospital charge 200% more than in MBS?

          • chriise on 14/03/2019 - 17:35
            +1

            @destination: They can. The cover you have appears to be the equivalent cover a citizen/resident would have through Medicare.

  • [Deactivated] on 14/03/2019 - 18:22

    What was the CT scan for?

    If it is not related to a problem she developed during her stay here, it won't be covered.

    Any reimbursement from them is purely a nice gesture and not in anyway because of policy.

    • destination on 14/03/2019 - 18:50

      Yes it is related for which she needs to be admit in the hospital.

      • [Deactivated] on 14/03/2019 - 19:09

        If it is related, the only other reason for rejection is incorrect itemised numbers and/or excessive fee for item.

  • [Deactivated] on 14/03/2019 - 18:47

    Many public hospitals have private imaging services which are tenants. Think of a hospital as more like a shopping centre with a bunch of private enterprises. The public part of the hospital would be akin to a large department store.

    You might be billed by the imaging department through the public hospital

    • destination on 14/03/2019 - 18:51

      Don't they need to tell us that the charge will be high and wont be covered by insurance. Intially we were told that Bupa will cover everything.

      • [Deactivated] on 14/03/2019 - 18:59

        It's not uber

        Find out who is charging you this amount? Somewhere a human is involved and will be able to assist. What does the ABN/ACN search say ?

        • destination on 14/03/2019 - 22:37

          I tey to spoke with them and their answer it this is what they charge.

          • Amaris on 16/03/2019 - 15:44

            @destination: Did they tell you this is by the public hospital and not a private imaging service contracted by the public hospital to work there?

            • destination on 16/03/2019 - 16:51

              @Amaris: No they didn't. Till today I was thinking that Public hospital will look after by Government and should be cheaper than private hospital.

      • CheapSticks on 14/03/2019 - 21:27

        Hey mate - public hospitals should not charge more than the prescribed MBS rate. Pls go and speak to them but before clarify with BUPA what does the $4k relates to? That CT scan is $1k difference - whats the remaining? You got to clearly understand the items where the over charging is happening which BUPA should be able to tell you and then you can speak to hospital about the target items.

        One piece of advice - next time take Allianz there cover is much better.

        • resubaehtgnolhcs on 14/03/2019 - 22:04
          +1

          As a private patient, public hospitals can charge you anything they like!

        • destination on 14/03/2019 - 22:40

          But they have already charged. I search the MBs list and for one of the particular scan it is $550 and they charge $1650. Isn't thay ridiculous.Everything I have checked is over charged. If they cant charge as you say then what should or whay can I do now?

          • resubaehtgnolhcs on 15/03/2019 - 19:48

            @destination: You can try and negotiate a smaller charge/gap, by stating you can't afford their charges. It is not uncommon for doctors and hospitals to change upwards of 10x the MBS for an item!

      • [Deactivated] on 14/03/2019 - 22:52
        +1

        Unless BUPA tells your that BUPA will pick up the tab unconditionally, who tells you what is irrelevant.

  • Halo375 on 14/03/2019 - 20:34
    +2

    If your family is from any of these fountries then they’re covered for free under our reciprocal health agreement:

    Belgium
    Finland
    Italy
    Malta
    Netherlands
    New Zealand
    Norway
    Ireland
    Slovenia
    Sweden
    United Kingdom

    • Msfrugal on 15/03/2019 - 11:06

      Halo375 - really ????? My parents are both in 80s and have private health insurance with a company that allows them30 days travel worldwide. I really want them to come stay 6-8 weeks but the cost of travel insurance is massive.

      So are you saying that if something happens they will be treated in public hospital here without any charge?

      • Baysew on 15/03/2019 - 19:17
        +1

        Reciprocal Health Care Agreements

      • Halo375 on 15/03/2019 - 20:04

        You’ll probably need to do a bit more research but generally the idea is that Australia would provide the same healthcare as we’d provide an Australian under medicare. Australians overseas in those countries would then be charged as a local too. Great in theory but I’ve no experience in practice I’m afraid!

      • OneJay on 16/03/2019 - 13:56

        I'm a NZ citizen with a Medicare card and without private health insurance. November last year I thought I might have a problem with my kidney so went to see a GP, who referred me to a renal specialist. I got a CT scan, wheeled around in a hospital bed and stayed for a few hours, and then discharged in the afternoon.

        Having no experience using GPs and public hospitals the whole time I was apprehensive about getting an invoice for the GP visit, and a few thousand dollars for the CT scan. At the GP I even hung around reception for an extra 30-60 seconds pretending to play on my phone half-expecting the receptionist to hand me an invoice before I walked out.

        I'm still thankful and pleasantly surprised up until now that it hasn't cost me a cent. Will be going back for a check up end of this month.

  • E C on 14/03/2019 - 20:54

    my advice as a layman - get a detailed itemized bill from the hospital then speak to the doctors for statements explaining why they found it necessary for the treatment. Ask BUPA to reconsider based the doctors statements.

    Bupa was very good when my mom got hospitalized at westmead public. They covered the ambo and a 2 night stay and the ct scan but it was so long ago I don't remember which visitor cover I took, but it was over a month so some waiting periods would have elapsed.

    • resubaehtgnolhcs on 14/03/2019 - 22:05

      BUPA has paid ($800), the rest is the gap …

    • destination on 14/03/2019 - 22:41

      Dr have already given the details to Bupa that why treatment is necessary at that time.

  • Hoju on 15/03/2019 - 07:36

    I’m curious - what hospital was this and what sort of influenza required CT scans? Most public hospitals are very judicious with their use of the scanners…

    • destination on 15/03/2019 - 17:29

      Its Auburn Hospital.

      • salekhard on 16/03/2019 - 14:28

        One of the worst from what I've heard from people working there.

  • ozbjunkie on 15/03/2019 - 14:50
    +1

    As high and dry said, go to the hospital and tell them you can't pay the gap. They should accept the payment from Bupa and wrote off the rest.

    Private health insurance is a joke, the same test is billed at eg 350 if you're a Medicare patient, and 950 if you're a private patient (happened to me before I cancelled my private health cover).

    No reason to have it other than tax purposes for locals, what a scam.

    • destination on 15/03/2019 - 17:31
      -5

      Yes its a scam but I beleive hospital is scamming people more than health insurance.

      • jimbobaus on 15/03/2019 - 19:11
        +4

        Hospital is not scamming anyone. It’s very common for the prescribed amount to be far less than the actual cost of the service. This is why gaps exist when it comes to a lot of medical treatmemts. The government sets the guidelines for what things should cost but in many cases the medical professionals charge more than this which results in your needing to pay the difference. Private’s health insurers only pay the prescribed amount in almost all cases. If you read your insurance policy you will see information about gaps and how it’s YOUR responsibility to check with hospitals, doctors etc as to whether a gap will apply.
        As has been said before chases up the invoice with the hospital and don’t let them fob you off. Your mum has the right to see what she has been charged for and dispute any transaction / charge she sees as unfair. However the hospital can charge what they want for services rendered.

        • resubaehtgnolhcs on 15/03/2019 - 19:50

          This ^^ …spot on!

        • ozbjunkie on 16/03/2019 - 15:04

          Yep - and my understanding is that the unspoken practice is essentially to overcharge private patients in order to effectively subsidise public patients.

          I don't mind the ethics of this situation (if indeed it is necessary) but I don't like the fact that for almost any procedure you'll be paying thousands extra with private health than in the public system. .

  • vr4indian on 16/03/2019 - 10:22
    +1

    So you paid for TOP MOST available product in market with ASSUMPTION that it will GUARD 100%.

    Sadly, there is something called GAP. While I understand that during visit to Hospital, reading TnC would be the last thing someone hope for.

    Its hard but try your best to convince hospital to reduce their bill or cost. Best of luck with BUPA mate.

  • ankor on 16/03/2019 - 11:17

    I've found Bupa's private health cover to be incredibly uncompetitive vs others like NIB.

    I hope everything works out for you.

  • dvd107 on 16/03/2019 - 12:03

    The difference between the MBS and what the hospital charges is the Gap.

    For a lot of procedures, the MBS rate (which is set by the government) is not enough to cover the cost of delivering the service. The government does not increase MBS rates every year with inflation. That's why there is out of pocket costs.

    As to people questioning why a CT Scan was performed in the first place, it would have been deemed medically necessary at the time.
    Without knowing the facts of how the patients condition at the time of the scan, we cannot comment whether it was necessary or not.

    e.g. The CT Scan might have been done in Emergency when the patient was short of breath/unwell, where as Influenza results are only available in 24-48 hours.

  • pippin88 on 16/03/2019 - 12:20

    Did the hospital obtain financial informed consent?

    I'm less familiar with overseas visitors, but think it is unlikely to be much different from Aus locals:

    As a health care provider, if you are performing a test or procedure that will cost the patient out of pocket, you must inform them of the costs and obtain financial informed consent.
    If you are only charging the medicare benefits schedule (MBS) fee or the private insurers "no gap" fee (therefore the MBS / insurer covers the whole cost), you don't have to do this process.

    The individual clinicians (doctors and nurses) will have no idea about what the hospital will charge for things unfortunately. (In the private sector in Australia, the doctors will know how much a procedure costs - as they are individually charging for it).

    If the hospital has not obtained financial consent by explaining the costs of investigations and treatments, then you may not have to pay a gap.

    However, the MBS fees do not reflect the full costs of a hospital stay. They are how essentially how much the doctor is paid for a procedure. The cost of the room etc is not covered by these items (these costs are often called 'hotel fees'). Medications and equipment are also not covered by the MBS.

    If you had an appropriate policy, then the insurer should be covered hotel costs etc. There will be an excess of course.

    Also, consider that an individual is liable for their debts. Relatives (e.g. children) are not generally liable unless they have agreed to be. A bad debt may implications for future visas though.
    (I am not a lawyer).

  • salekhard on 16/03/2019 - 14:33

    This seems to be a massive issue in the Indian community who have elderly parents who come to visit, and then get admitted to hospital because of an issue, and then have insurance that doesn't cover what they thought it would cover.

    https://www.sbs.com.au/yourlanguage/punjabi/en/article/2017/…

  • Amaris on 16/03/2019 - 15:51

    If you don't manage to get the hospital to reduce charges there's always the option of paying in small instalments. As far as I know, hospitals don't employ debt collectors and are pretty relaxed about debts.
    Hope you manage to get the gap waived!

  • roddo on 16/03/2019 - 17:56
    +4

    I work in the medical profession. BUPA are the WORST health insurance company. Their fee to specialists/surgeons/anaesthetists is regularly below what HBF or medibank private would pay. I don't charge a gap, but surgeons and anaesthetists who I work with do, and they tell the patient why - it's because BUPA pays them less than HBF. These guys don't gap HBF/medibank or most other health funds. I would avoid BUPA, they're no good.

  • [Deactivated] on 16/03/2019 - 18:21
    +3

    They did same to a friend of mine.. His father had a stroke which was the first occurrence which even doctor provided a letter. Bupa argues the deterioration of health is pre existing hence they don't get covered.. is a big scam.. friend was out of pocket over 40k.. completely ruined his life eventually.. he gave up living in Australia and went back to hometown with his family as he couldn't even afford to fight them and was completely distressed.. Now he is still paying the installments for the hospital bill.. I hate Bupa for what they did.. I would suggest everyone to steer clear.. Their policy is most attractive but they are a big fraud..

    • CheapSticks on 16/03/2019 - 19:48
      +1

      Agree i have heard similar stuff. I am told Allianz is way much better.

  • destination on 04/04/2019 - 13:18

    So I was able to negotiate with hospital and hospital agreed to give 10% discount (with the clause if I pay full amount) which is not much but still something is better than nothing so I accept it and paid the rest amount.

    Thanks Everyone for sharing ideas and knowledge. Really appreciate it.

  • kiitos on 11/04/2019 - 18:25

    Would travel insurance have covered her more completely?

  • Zasuma91 on 08/03/2024 - 03:53

    Hi. May I ask what your mom visa is and what policy you have from Bupa? Did they pay for hospital accommodation in full? My mom visa is 870 and has Standard visitor cover but Bupa said they only pay appx 500$ per day for hospital accommodation which is way less than the fees charged by hospital 2700.

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