So I need to have a pretty major spinal surgery that's not covered by medicare. I don't care about tax benefits or extras really. The operation will cost around $50-$60k so I just want a fund that will cover as much of the cost as possible.
Would love some recommendations on which private health funds are best for this type of thing, or are they all much the same and I should just shop on price?
I'm far from an expert but i think they all have to max out at 12 months waiting for pre-existing
They pay out differently, ask your doctor which one(s) they like.
Yep, this makes a lot of sense if you’re going private. If you already know which surgeon you’re going won’t talk to them their admin/nurse about which fund is easiest to deal with and patients haven’t had issues claiming with. Also remember the 12month waiting period for private health insurance. Also make sure they cover whatever surgery it is at the tier you sign up for with your indication.
The operation will cost around $50-$60k
Yeah mate gotta find out what cost around that, and then ask the health funds how much they cover. Guessing hospital bed, theatre room, anaesthetist, surgeon fees etc.
Suggest you call up Medibank first get an idea what they cover. Then use that knowledge to shop around.
You will need to serve waiting period, up to a year, and won't likely have the entire $60-$70k covered
Depends on the breakdown of the expected expenditure, viz. doctor, hospital
… major spinal surgery that's not covered by medicare.
I could be wrong, but I thought that private health only covered items listed on the Medicare schedule.
Have you tried asking the doctor/surgeon what their patients usually do about their payments? They might be able to tell you whether patients tend to go with any particular insurers etc.
Services not listed on the MBS like laser eye surgery and cosmetic surgery can be covered by private health insurance.
check that back, neck and spine is covered and rehab, many silver policies cover these 2, and ask the doctor if any parts of his surgery have item numbers, then check the fund covers his particular hospital, then read the fund rules and booklet, see if there is any type of aftercare, and also look for a fund with the best refund rates like HCF, then ask any questions. They have a list of hospitals they pay more to. Not every hospital is covered. I check which rehab hospitals are on it too.
Medibank Private were great with our daughter's spinal fusion, but as lookin4bargain said, you have to check using the item numbers - the doctor should be able to provide them for you. And check if you get better payouts with each level of cover.
One of the mums in our private scoliosis group found out way to late that her fund didn't cover her daughter's surgery.
And the biggest cost was the anaesthetist - but it is a very complicated anaesthetic in this type of surgery.
make sure you get the right cover for your type of surgery.. i was once screwed over by medibank for they gave me the wrong level of cover. i went to the chadstone branch, gave the guy the quote (with item numbers etc) of the surgery i was going to have. signed up with the recommended cover. fast forward to one and a half years later, the day before my surgery, i was told by the hospital the cover i had with medibank do not cover the surgery i was going to have. imagine the stress i went through before and after the surgery trying to get things sorted.
Were you covered in the end?
i did get some money back. at that point i kinda had given up chasing them, whats covered whats not etc. it was a mess.
If you get cover for pre-existing after a year I now understand why my heath insurance costs are so high…
and you yourself could be in the same position, not many have perfect health
Which is why I pay for private health insurance each year. It seems wrong if someone can pay a grand or two, wait a year, and claim tens of thousands.
and I pay and never use it, so he can take my place
@screensaver: You wouldn't prefer to pay less each year rather than than contribute to cost of surgery for random person?
OP can you post the item numbers and breakdown for the cost?
You might find your best bet is to do this in a public hospital.
Are you sure it wouldn't be better to just go on the waiting list to get it done in the public system? You will have to serve a waiting period and then still wait a while after that if you want to get it done privately and have it covered.
Public waiting lists can be massive though. In many places a simple endoscope can have a 2 year waiting list. Gonna suck if there's cancer down there.
One thing I recommend related to item numbers and quotes is to do it over the phone. I was shafted at a PHI where I was an employee because I went and got my quote checked at a branch. The branch manager knew that staff member, and sided with me said they couldn't make the adjustment as the amount was too big. I eventually went through the ombudsman who said to me never go to a branch (always over the phone) to check quotes as it's very hard to dispute a case of he said, she said. The fact that the staff member who served me was so terrible at their job, they didn't leave notes or anything of the sort on my membership was to the PHI's benefit. It was like I never had the quote done. In the end I was out of pocket about half, $1000 or so. Not a massive amount but not pocket change either. The whole affair was pretty annoying granted I was an employee and the manager of the branch kinda knew I was right.
When done over the phone, they can pull up the phone records to see exactly what was said. I don't know if all funds have this option but I imagine most of the larger would have it?
I would go mainstream e.g. BUPA for now. This will give you the widest set of options re: hospitals, doctors etc. The last thing you need to worry about is whether the health fund will cover you fully at a particular hospital etc.
Later if you want to keep on with Health Insurance, you can review the market and do your tradeoffs, and transfer to a fund more in line with your longer term needs.
Depending on your age and eligibility, if you have to wait a year, I'd potentially look into moving to one of the many European countries that have proper healthcare, or going to Thailand (South Korea could be an option but I don't know if the cost is high for foreigners) and paying out of pocket if you need/want to do it sooner.
Donr forget to include pain management with device, in case you need it
Most policies will have a waiting period and may exclude pre-existing conditions.