Health Insurance for Dental Surgery help (under General Anaesthetic)

n4rut0 on 12/06/2020 - 01:11

Hello all, it's come the time for me to have my wisdom teeth removed and unfortunately they are located under my gums which means it will be a surgical procedure. The specialist has recommended me do it under GA for other reasons as well.

My question is should I pay for private health insurance and if so which one? The cost to remove 3 teeth are $1440, ~$550 for the anesthetist and about $900 for the private hospital fees. I'm about to turn 25 and studying full time so I would like reduce the costs as much as possible. Does medicare cover any of this? I can postpone the procedure if I have to but would like to have them out by the end of the year.

Health & Beauty

Comments

  • triviums on 12/06/2020 - 01:35
    +1

    Medicare can in certain circumstances cover wisdom teeth removal (depends on state and individual circumstances).

    If you do happen to find a way to get your wisdom teeth removal covered by medicare I am doubtful you will get it done this year. The waiting list is long

  • holdenmg on 12/06/2020 - 01:59
    +1

    If under 25, are you a Student dependant or an Adult dependant?

    You may have some private hospital cover from your Parent Policy if you are a Full Time Student and still living at home.

    If not you may be regarded as an Independent adult (and would be if over 25).

    Check and see if you can have any waiting periods waived before you turn 25 if there is any existing cover.

  • brokenglish on 12/06/2020 - 02:09
    +2

    should I pay for private health insurance

    You don't currently have Private Health Insurance?
    Generally there is a waiting period (6-12 months) after you sign up before you can claim on Major Dental procedures.

    I had 4 removed under GA recently. Just to give you an idea:
    - Specialist fee to remove 4 wisdom teeth $1940 (2x Item 323 and 2x Item 324).
    - Anaesthetic fee $325 (Gap payment after Medicare).
    - Private Hospital fee $250 (Private Health Insurance excess).
    Then I received $550.20 back for the Specialist fee from my Private Health Insurance.
    Seeing how much I've paid the insurance premium over the years, it wasn't worth it for me. A reset button would be good.

    Does medicare cover any of this?

    Contact your dentist/surgeon office if the quotes you received are after/before Medicare.
    They get this question all the time.
    You may be able to get lower fee if you don't go through insurance. Don't be afraid to ask. You are paying them $.
    Remember your dentist/surgeon, anaesthetist, and hospital are 3 different entities. You may need to ask each one.

    I heard Medicare has a long waiting list but I never explored this option.
    Whenever I told my colleagues how much this cost me they always told me I should've gone to India/Thailand/Bali to get them removed for under $300 😂

    Recovery’s a biatch, good luck!

    • modsec802 on 12/06/2020 - 07:17
      -2

      Private Hospital fee $250 (Private Health Insurance excess).

      The actual fee would have been thousands of dollars and you only paid $250 and are questioning whether having private health insurance is worth it?!?

    • chriise on 15/06/2020 - 20:23

      I'm doing my homework on this at the moment, and hoped you could clarify something for me… Does the PHI only cover the cost of the hospital stay? Were the 2x323 and 2x324 items covered by only $550 because of your extras cover? Or were those items only somewhat covered because of your PHI cover?

      • brokenglish on 15/06/2020 - 20:26

        I had Hospital Cover and Extras Cover on my PHI. You are correct.
        No Hospital Cover > pay the full hospital fee.
        No Extras Cover > won't receive $550.20 back.

        • chriise on 15/06/2020 - 20:38

          Ah, so no matter what PHI you have, it wouldn't have made any difference to the specialist rebate - that's all in the extras you choose. thanks.

        • modsec802 on 15/06/2020 - 20:50
          -1

          I don’t think this is correct. Extras cover is for auxiliary services our of hospital like physio and dental - not specialist services in hospital. The specialist services in hospital are covered by Medicare to 85% of scheduled fee with private health hospital paying the ‘gap’ to the scheduled fee. A lot, if not most, specialists charge a lot more than the scheduled fee.

          • chriise on 15/06/2020 - 21:03

            @modsec802: Hmm ok.. When searching a couple of insurer websites, I couldn't find the limits/caps that would be applied to certain hospital items, unlike the extras page where they list all the limits.

          • chriise on 15/06/2020 - 21:08

            @modsec802: So if Medicare would have covered 85% of the scheduled specialist fee, that means the scheduled fee should have been around $647. Medicare covered 85% which is $550. Only not in this case, as the $550 is the PHI rebate… So possibly PHI covered the full scheduled fee which is set at $550 and the surgeon charged over the scheduled fee creating the gap.

  • modsec802 on 12/06/2020 - 07:19
    +2

    You can’t just sign up for private health insurance when you need something done, use it and cancel it. It doesn’t work like that - imagine if everyone just did that 🤦‍♂️

    • holdenmg on 12/06/2020 - 07:41

      It would be like multiple smash and grab raids every day but at Hospitals instead of Banks.

  • Oofy Doofy on 12/06/2020 - 08:14

    Wisdom teeth removal is totally dependant on the Doctor's opinion. Depending on your particular situation, getting another opinion or two would be worthwhile. Sometimes the justification for removing them is a little bit of omission of details and wanting the work, instead of the wait and see approach over several years.

    In other words, not practising good medicine. Happens all the time.

  • jjjaar on 12/06/2020 - 08:14

    I can postpone the procedure if I have to but would like to have them out by the end of the year.

    Then you’re out of luck re: health insurance as most will have 6-12 month waiting periods, so you won’t even begin to consult specialists until mid December at the earliest.

  • cheaplee on 12/06/2020 - 08:19

    It's the same with public health insurance (aka Medicare) - good value for those that use it a lot, just a tax for those that don't.

    This year with your claims you may break even. Next year you will be out of pocket. Ultimately it depends if the tax for NOT having insurance is more than the insurance. Anything you can get out of it is icing on the cake.

  • mooney on 12/06/2020 - 08:31

    As the issue is now known and will be captured in your dental records, is this now not a pre-existing condition?

    I would check because you dont want to pay a years worth of Health Insurance only to find out they will not pay.

    This is from Australian Unity: "A pre-existing condition is any illness, ailment or condition where, in the opinion of a medical advisor appointed by Australian Unity, the signs or symptoms have existed at any time during the six months up to and including the day on which you became insured under the policy—regardless of whether you were aware of it."

  • tulip99 on 12/06/2020 - 08:50

    I got my top 2 wisdom teeth out 13 years ago. I had it done at day hospital under general anesthetic as I had deep roots and the teeth were decayed as I couldn't get to them with my toothbrush properly.

    It cost me approx $2k and I didn't have private health insurance. The anesthetist cost $550, the surgeon $500, and the day hospital the rest. I got some back from Medicare for the anesthetist but was out of pocket for the rest of it.

    I couldn't chew for a week. I lived on milkshakes and chocolate Foster Clark Snack Packs :-) I couldn't even eat soup unless I blended it up and gummed it down. I found Panamax pain killers helpful. They gave me Panadeine Forte at hospital but it didn't do anything for me.

    Hope this helps.

  • screensaver on 12/06/2020 - 09:53

    I went to the dental hospital in Sydney for free. Need health care card. They have an oral surgery dept, I had a root removed. I did not have anaesthesia, the guy was good, very experienced

  • Jade81 on 12/06/2020 - 10:51

    I had this issue. I signed up with the minimum cover for that surgery with Bupa and booked it in for the 1 year mark as I couldnt afford it otherwise.
    That was a long time ago.

    Since switched to HCF as was better cover for me.

    I suggest getting all the item codes and prices and checking with Medicare and any not for profit health fund how much or if each will pay.

    I never use sites to compare, it's worth possibly hundreds of dollars to do the legwork yourself especially if you avoid funds with shareholders

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