Using Private Insurance at Public Hospital

Bunnyburger on 11/03/2021 - 17:12

Hey all,

I had surgery recently at a public hospital and I gave them my private health insurance details so the hospital would get funding. In doing this, I chose to be and was admitted as a private patient. They gave me a guarantee that all my expenses would be covered by the hospital.

Because this was fairly recently, nothing bad has happened yet, but I was wondering about the downsides of doing what I did. I did want the hospital to get funding and I did want my insurer to actually do something for once. I do feel a bit uneasy about what I did due to the possible unknowns. I received no benefit whatsoever by doing this.

Can anyone provide some advice on this or share their experiences?

Financial Health Insurance Insurance

Comments

  • PissLUR on 11/03/2021 - 17:16

    do you have to pay excess?

    • Bunnyburger on 11/03/2021 - 17:42

      That's covered too under the guarantee. It's one of the first things mentioned.

      • PissLUR on 11/03/2021 - 17:48

        ooh nice.

  • Xenocaust on 11/03/2021 - 17:20
    +2

    You'll probably have to pay the excess and for any medications prescribed while an in-patient.

    I had a similar opportunity to use my private insurance for minor surgery, and could not see the benefit to me, other than a private room the night before the surgery. As it was, the public option would have had me on a trolley in a corridor, so I went home - which was my preferred option anyway.

    • Bunnyburger on 11/03/2021 - 17:41

      The letter said they'd pay the excess too. I was placed in a 4 bedroom listening to people suffering all night :(

      • Drakesy on 11/03/2021 - 18:14
        +5

        Sounds like you got public level care at private hospital costs (they got to chase your provider for funds)

  • Ocker on 11/03/2021 - 17:32
    +2

    People pay taxes and the medicare level to fund the hospital system. In nominating your health fund it will only serve to increase the premiums of the fund.

    • jv on 11/03/2021 - 17:52
      +9

      In nominating your health fund it will only serve to increase the premiums of the fund.

      Why pay your health fund premiums if you're not going to use them?

      • Drakesy on 11/03/2021 - 18:14
        -1

        To reduce your Private health fund levy.

        • bobbified on 11/03/2021 - 18:23
          +1

          The money has to come from somewhere - If it doesn't come from a private health fund, it'll come from the hospital's funding, which is taxpayer's money.

          • Ocker on 11/03/2021 - 19:06
            +1

            @bobbified: My point exactly, I pay my taxes so why pay an increased health fund premium to cover what I am already forking out for?

            • bobbified on 11/03/2021 - 20:22
              +1

              @Ocker: If the claims aren't made, then the profits go the shareholders. We really don't win either way! lol

    • bobbified on 11/03/2021 - 18:20
      +8

      According to the new reports I've seen, he's at the Alfred Hospital.. that's a public hospital.

      • jv on 11/03/2021 - 21:04
        -3

        He was in a private hospital for a while before being transferred to the Alfred.
        His publicists must have realised the hypocrisy…

        "The 48-year-old was transferred from Peninsula Private Hospital to the Alfred Trauma Centre"

        https://7news.com.au/lifestyle/health-wellbeing/daniel-andre…

      • netjock on 11/03/2021 - 21:09
        -1

        But he probably has better treatment than any Joe or Jo that is admitted.

        Probably should put him with 3 others in a shared room and let them hear the miserable sounds of suffering.

  • RedBlueRedBlue2000 on 11/03/2021 - 17:52

    Elective surgery = you pay the excess and any other gap fees after surgery (if you decided to select your own doctors). The gap bills arrive a few weeks after your surgery.
    Emergency surgery is generally covered by the hospital and in your case part of the costs funded by insurance. There shouldn't be any other fees in an emergency surgery situation aside from medication prescribed on your departure as an out-patient.

    • YesPleaseThankYou on 11/03/2021 - 17:56

      There's nothing about it being an emergency in the OP.

    • Bunnyburger on 11/03/2021 - 18:06

      Ah I didn't get to pick my own doctor. They said I don't get to as well since it's a public hospital.

  • colcha on 11/03/2021 - 18:08
    +4

    Whilst what you are doing is altruistic, you are in fact increasing your health funds costs. If too many members of your fund do the same thing, this puts upward pressure on your premiums.

    I am happy to contribute extra if I am receiving something in return - in your case, you received nothing extra from the hospital. I was faced with a similar situation last year, I told the admissions person that I would only agree to be admitted as a private patient if they found me a single room. Later that evening, a single room was found.

    • Bunnyburger on 11/03/2021 - 18:18

      Darn I guess I was a bit naive here, even the hospitals are companies in a sense I guess…

    • peter05 on 12/03/2021 - 01:28
      +2

      although this is correct in the most factual sense, we can take a step back and consider that using private at your local public hospital always is the correct decision even if it increases the premiums. If you assume that members are going to utilise their insurance anyway, you may as well have the additional funds go to your LOCAL hospital so that you have a chance of improving their service for yourself and all community members in the future. By claiming on your health fund at your local hospital you are tipping the scales a little bit so that they can maybe afford a new machine or staff member etc

      Its particularly important as many public hospitals only work in particular catchment areas so you really do want your local do be doing as well as it can financially

      • [Deactivated] on 16/03/2021 - 12:06

        And, most importantly, your premiums are going to go up 6-9% anyway no matter what you do. So may as well just use it.

  • Drakesy on 11/03/2021 - 18:16
    +2

    Yep, shouldn't have given them your private health number as they didn't seem to admit you as one, especially if you were sharing a room.

    Looks like they wanted a way to cover costs and your healthcare provider footed the bill. You get no benefit while they got their costs covered.

    • Bunnyburger on 11/03/2021 - 18:24

      As the posts mount up I'm beginning to feel a bit dumb here. Maybe I just contributed to a hospital exec's raise or something. Here I was thinking I was helping out a respected public institution like the NHS.

      • Drakesy on 11/03/2021 - 18:35
        +2

        Don't worry i would've done the same.

        The very least they should've done is given you a private room.

        • holdenmg on 11/03/2021 - 19:51

          …and a Newspaper. lol

        • Eeples on 12/03/2021 - 01:19

          I believe getting your own room depends on the inclusions in particular private health insurance policies and the availability of the room.

          • Tonyh87 on 12/03/2021 - 11:26

            @Eeples: Private room depends on availability an clinical need for isolation from other patients (eg mrsa or vre infections). If there is a room available, it would likely go to a private patient before a public patient. Apart from that, the only other benefits are usually a daily newspaper and free tv hire.

            • Eeples on 12/03/2021 - 11:36

              @Tonyh87: Pretty sure, I just said that ?

              • Tonyh87 on 12/03/2021 - 11:41

                @Eeples: Sorry. Wasn't disagreeing, just elaborating

      • netjock on 11/03/2021 - 21:11
        +1

        NHS isn't respected. Nurses have been offered a 1% pay rise. The clapping was actually sounds of slap in the face.

        Until they put politicians in public hospitals within the same offerings as the people they serve the system will always be the budget whipping child.

        • Emerald Owl on 12/03/2021 - 01:48

          Isn’t that costing 1 billion dollars? How is that country going to pay for that?

  • MS Paint on 11/03/2021 - 18:38
    +1

    I used PHI for a regional public hospital for my daughters elective surgery.

    No out of pocket costs and my daughter was treated like a Princess.

    Main reason was it was the closest hospital her specialist used and the secondary reason was for a ROI for this sh!t tonne I have contributed to said PHI.

    • Drakesy on 11/03/2021 - 18:43

      The question is would that service of been any different had she been admitted as a public patient.
      I'd say the quality of service in some regional hospitals sh1ts on many inner city hospitals due to the staff/patient ratio.

      • MS Paint on 11/03/2021 - 18:46

        Probably not, but it was a very personal and stressful event for my daughter and she couldn't compliment them enough.

  • MondaySleeper on 11/03/2021 - 18:53
    +4

    Hospitals get the funding through a channel called activity based funding which depends on the treatment coding. When you are a private patient normally you pay some excess and the fund pays the rest (Accommodation). Also for inpatient medical, its under 75(Medicare)/25 (Fund).

    If you are a public patient, Hospital cant charge you. But if you are a private patient, you will have to pay excess. So hospital will ask you to be a Private patient and will write off the Excess ( i.e if the Accommodation is $1000 and excess is $200, hospital invoice healthfund $800 and the $200 will be adjusted off). This way this is good for hospital which is already struggling with low funding.

    When they ask you to be private, always make sure that the excess is waived. Also ask for some extra benefit if available (like single room if your fund allows that).

    So nothing wrong with what you did, but probably helped the under-funded hospital.

    • Ocker on 11/03/2021 - 19:08
      +2

      "probably helped the under-funded hospital" - so make the government fund the health care system properly and stop them double dipping- taxes and health funds

      • Drakesy on 11/03/2021 - 19:54
        +1

        And forcing people onto the public health levy to pay double for the same amount of health care. Subsidising the burden of pensioners on the health funds. It's one big transfer of wealth.

      • netjock on 11/03/2021 - 21:14

        Fuel excise is another one where the money doesn't go back into roads. If politicians would just be honest about their treatment of tax payer money like it is some slush fund.

    • Bunnyburger on 11/03/2021 - 19:12

      I did what I did because I saw bits and pieces of hospitals being privatised, like the X-rays and pathology.

      Yeah they'll write off the excess, the guarantee basically says there will be no out of pocket expenses for my treatment.

      Thanks for letting me know how it works.

  • bargain huntress on 11/03/2021 - 19:15
    +5

    you got a guarantee that it wouldn't cost you anything and it wont

    i don't think you should be worried, just focus on your recovery

    when i had radiation in a public hospital they offered me free tv if i let them charge my insurance

    they also told me how the money - either from people paying for tv, or (some? all?) from charging their insurance to pay for tv and other stuff - was used for some of their harder to fund projects like decorations during the holidays and stuff for the volunteer groups

    it made me feel a little happier to do it because they guaranteed it wouldn't cost me anything and i felt like i was helping

    i got my own room anyway because radiation

    i don't think you should feel dumb, you did a nice thing

    anyway on the remote chance someone screws up and it did cost you something, make sure you raise a stink the likes of which they will remember (which in a public hospital is an achievement) and don't pay anything

    • Bunnyburger on 11/03/2021 - 19:30
      +1

      Thanks, I hope it doesn't come to that. And I sure hope the money goes to where it should.

  • netjock on 11/03/2021 - 21:17
    +1

    I wouldn't be to guilt ridden. I am sure health funds aren't like car insurers and affecting your no claim bonus. It isn't like health fund bosses will be giving it back to policy holders, they will just go home with bigger bonuses.

  • Eeples on 12/03/2021 - 01:13

    With my private health insurance the benefits have been…. (when choosing private patient in public hospital)….

    1. Own room, if one available.
    2. Free TV

    However, if your stay was because of an accident for example in which you later receive compensation (not income protection insurance) then your private health fund might pursue YOU to recover their costs after you receive your compensation. (I only know this anecdotally).

  • Brydie76 on 12/03/2021 - 07:29

    Did this about 6 months ago for day surgery, was admitted as a private patient- absolutely no difference except I got a food voucher (which I gave to my partner to use while he waited). A couple months after my insurer sent me a statement of benefits showing they paid about $140 to the hospital. Got another one this week showing another statement- but nothing paid by my insurer as Medicare had covered it all. I daresay that this will vary for overnight surgery but I had no difference in care or payments and really my insurer paid out less than they do each year for my glasses. Hope this helps :)

  • backpaqer on 12/03/2021 - 07:40

    Friend did same…private patient in public hospital. As a private patient he got the $20,000 stent used in his heart instead of the $7,000 one that public patients get which usually fail over time and require another one several years down the track. You might not notice the difference, but they will have used better medical supplies.

    • reactor-au on 12/03/2021 - 09:25
      +1

      Is this documented?? Scary.

      • netjock on 12/03/2021 - 10:15

        I'd want to keep the paperwork. You know the thread is a few years about the $20k stent and whether it should be covered by ACL.

        • holdenmg on 12/03/2021 - 10:19

          Can't get Price Match @ Officeworks or Bunnings on Stents lol

  • [Deactivated] on 12/03/2021 - 08:02
    +3

    This is why I quit private medical insurance. It's too scary not knowing if the insurance company will turn around and demand payment for a litany of things from excesses to deciding you're not covered for whatever.

    There's literally nobody to explain what the risks are of using private health insurance.

    I'd rather just go as a public patient and at least I know where I stand.

    What is the point of paying thousands of dollars for something so complicated you're too scared to use for fear you'll get charged an additional ton of money?!

    • fishfingers on 12/03/2021 - 16:22

      The only point I see for having PHI is not having to join a very long waiting list for treatment/ procedures. We have had it for 20years but always used the public system (2 pregnancies) to avoid the extra charges but for elective surgery we have not had to wait long and were not out of pocket going in as a private patient with all costs waived (so no gap) by the hospital. No noticeable difference to our hospital experience and we felt good about letting the hospital charge our mostly unused insurance.

  • Bob Svargis on 12/03/2021 - 09:28
    +3

    You did the right thing using your insurance.

    There's no guarantee that you're going to get a private room, but it does give you priority… until someone comes in that really needs it due to medical reasons. You probably already know this, I'm just repeating what my other half tells me (she's a NUM in a public hospital).

    She's regularly having to reset expectations with patients who sometimes think that they're entitled to the best room in the place because they are using their private insurance, but it just doesn't work that way. Sometimes there will be a patient that needs it more, irrespective of insurance. Sometimes you'll do well, sometimes not so much.

  • Darayus on 12/03/2021 - 09:40

    I had my Nasal surgery in 2019 in RPA Sydney. I had choice of my surgeon who is 2nd best in Sydney to operate, best support team and doctor, I got admitted as private patient in public hospital. With that I only have to pay one day stay gap per my PHI and all charges were charged back by my hospital to insurance. I am paying my PHI for last 20 years and this is the first time i used my insurance. Had i gone as private patience in private hospital then i would have to pay about $ 15K excess and surgery within 2 weeks but here i have to wait for 3 months which i was OK. I can say that my PHI insurance starting from Hxx was not happy and asked me to filled out the survey as to why i selected Private patient when I can be treated free in public hospital and did they insist that i should provide them my private insurance details.

    So it would be advisable to support the system and if you have private insurance and had to use public hospital then it would be good that you provide them your PHI details so that they can get contribution from your premium you had paid for ages and also reduce flow back of excess dividend they give it away to thier share holders.

  • ozbjunkie on 12/03/2021 - 10:04

    Seems there's a thinking here in the comments that people should pay private insurance to avoid paying extra public health costs, and then they should use the public health system.

    Yes let's definitely pay money to insurers and take from tax funds. In fact, why not just give the tax funds directly to insurers and not require them to do anything.

    If you have insurance use it - at least if the excess is guaranteed paid by the public hospital.

    • netjock on 12/03/2021 - 10:19

      In fact, why not just give the tax funds directly to insurers and not require them to do anything

      That is the private health care rebate that comes off the gross premium.

      PHI is one of those government subsidies that a liberal government hates (giving subsidies as it isn't free markets) but yet choose to do so. I am thinking it is all their rich mates who want cheaper premiums. Otherwise it would be the 1% who would have PHI and it would be very expensive.

      • ozbjunkie on 12/03/2021 - 18:11

        I think it's motivated by politicians all having interests in investment funds (managed, super) that are highly invested in the insurance industry. That and their mates might work there, hell the politicians might work there before or after their " public service".

      • Drakesy on 12/03/2021 - 19:21
        +1

        Funny thing is that the liberal government was the one that brought in the Private health penalty (Medicare levy surcharge) for those earning over $90k to ensure their Private health fund mates get a guaranteed membership basis.

        Basically Howard in cahoots with the private industry.

  • Noy on 12/03/2021 - 13:33
    +1

    I don’t care so much about the accommodation but I do care about selecting the medical staff who operates on me and what equipment is used in the theatre. Surgeon or registrar under surgeon ? Specialist anaesthetist or ? That’s what matters for me with my PHI in a public hospital.

    • Bunnyburger on 12/03/2021 - 17:24
      +1

      Yea that was my main concern. The surgeon I wanted specifically said he'd be doing it himself right before we entered the theater. But there were a bunch of student looking people inside. Uh oh

  • follow on 12/03/2021 - 18:01

    so, i understand this correctly, you were already on the public waiting list or having emergency surgery? Then you offered them to use your private health? So that the public hospital would get something out of it?

    I never thought of it like that. Kids are free under most PHI so might be worth using PHI if they get surgery in the future.

    • Bunnyburger on 13/03/2021 - 22:40
      +1

      I was already on the public waiting list. Yeap, I offered to use my private health on the day of surgery.

  • Never Pay RRP on 13/03/2021 - 22:15
    +1

    There will be no downside or nasty surprise for you. You did the right thing

  • bicor100 on 15/03/2021 - 00:35
    +1

    Don’t worry, you have done the right thing using your PHI.

    For every hospital admission, the hospital normally gets paid by the government a set amount of money depending on what the admission was for. By nominating your PHI the hospital generally gets more money from your PHI than from the government.

    I wouldn’t worry too much about your premiums going up. If they go up, they’re going up regardless of whether you had your surgery in a public or private hospital. Premiums go up because you may develop a chronic condition that makes you more likely to use your insurance. If you don’t tell your PHI about a chronic condition you’ve developed, that’s against their conditions and they might refuse to pay any costs relating to that condition in the future.

    Using your PHI doesn’t tend to get you a whole lot of extra perks in a public hospital. You still have every chance of being stuck in a 4-bed room with a wandering dementia patient. Your surgery can still be bumped down the list if an emergency comes in and needs to be operated on before you. But at least you can sleep better knowing that you are contributing to an underfunded and under-resourced hospital without any significant disadvantage to yourself.

    • YesPleaseThankYou on 15/03/2021 - 15:43
      +1

      Premiums go up because you may develop a chronic condition that makes you more likely to use your insurance. If you don’t tell your PHI about a chronic condition you’ve developed, that’s against their conditions and they might refuse to pay any costs relating to that condition in the future.

      This is absolutely incorrect when it comes to private health insurance in Australia. Refer sections 55-1 and 55-2 here https://www.legislation.gov.au/Details/C2020C00026

      The non-discriminatory position detailed in legislation is also reflected the various fund rules, which you can find on the insurers' websites.

      Depending on your policy, it may apply to life insurance, and it may apply in the USA, but it does not apply in Australia.

  • trapper on 17/03/2021 - 17:26

    The only difference I noticed by going private in the public hospital was the TV was included. Normally as a public patient you would need to pay some fee to have it activated.

    A potential downside I did wonder about was the incentive to push my surgery back to keep me in hospital longer (so they can charge more to the insurance)

  • Bunnyburger on 14/04/2021 - 17:21

    Just an update. I called the hospital, they haven't even filed the paperwork to claim insurance.

    This is kind of inconvenient if you want to change insurance plans or seek closure.

    I wouldn't do this again for nothing given the risks and uncertainty involved.

    • YesPleaseThankYou on 15/04/2021 - 15:52
      +1

      Check with your fund, but I am sure that you will find that so long as you were insured at the relevant time (and otherwise eligible to claim), then you will be OK to terminate the insurance or change funds.

      • Bunnyburger on 15/04/2021 - 16:04

        Yeah I figured that was generally the case. I'm pretty sure what you said is correct but I'm just scared, that's all. Insurers will do anything to weasel out of paying for a claim.

        My case is pretty clear cut but it still worries me.

        • YesPleaseThankYou on 15/04/2021 - 16:05

          Write to your fund and get it in writing.

          There's nothing to be scared of.

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