I need an elective surgery for a pre-existing condition at a private hospital, within 3 months
Currently without insurance. Is there any options without a waitlist?
Public hospital waiting period is insane
Appreciate the help
Health Insurance without Waiting Period
Jason Black on 05/07/2024 - 01:00
Last edited 05/07/2024 - 14:11 by 1 other user
Last edited 05/07/2024 - 14:11 by 1 other user
Poll Options
- 4Yes
- 55No
Comments
Because OP NEEDS it at a private hospital and NEEDS it within 3 months. Duh
Because OP is the king of Australia
This comment seems to imply health insurance is a zero-sum game between customers, covering the free-market price of health care when needed, which is laughably naive.
I agree. Makes sense
Please explain why you think people like myself should pay to subsidise your decision to not chip in, then skip the queue?
True
Forget insurance and just go overseas. Maybe it's still cheaper than paying for the insurance for the min wait duration.
For some reasons, private health insurance in Australia is unlike your usual insurance, say compared to car insurance. The PHI has little benefits (many exclusions, very low limits, etc) for the paid premium. It's like its sole existence is only for people to avoid the medicare levy surcharge. For an (exaggerated) illustration, one year of PHI costs you $5000, you need a surgery that costs $10,000, then PHI will only cover $6000 for you. So effectively you only get $1000 as a benefit of using insurance compared to no insurance. And that's assuming you only had that for a year.
you need a surgery that costs $10,000, then PHI will only cover $6000
That's seems extremely inaccurate from my experience. A $27 000 surgery left me with an out of pocket of $500 for the surgeon, including multiple consultations and $150 for the anesthetist, including pre-surgery consultation and assessment. I was/am on top hospital cover.
Its all about who you with and the level of cover there are hundreds on different cover premium out there from all provider combined
That seems hard to believe. And you conveniently left out one of the important detail: How much you are paying for the cover every year?
So which PHI and exact plan are you on?
Not hard to believe at all, that's the whole point of private healthcare - no wait and very low cost.
I had two surgeries in the past year and both times I only paid a $500 private hospital excess. Only other cost was the prescriptions.
Insurance costs $159.13pm and also covers my kids.
@trapper: wow your insurance seems good. mind to share? provider and cover name? and what kind of surgery you did?
@CyberMurning: It's Bupa, would need to look up the plan, but it's pretty standard mid-level kind of plan.
I got a broken bone surgically fixed, then another surgery six months later to remove all the hardware.
That was with Bupa, top hospital cover. Whether you believe it or not, it's what my total out of pocket expenses for a total hip replacement, and included 5 weeks of rehab, with 2 x 2hr sessions/week.
It appears you’re projecting how private health Extras cover works onto Hospital cover. Hospital cover doesn’t work that way.
As I said, that was an exaggerated example. The extras cover is even worse.
AKA - False, bogus, fabricated, made up.
Yes that's my experience. $7000 procedure, and I had to pay $2500 for hospital excess and specialist gap fees. Maybe I could have got it done to excess only if I shopped around but the process is so opaque. It's not like they clearly invoice you with all the charges beforehand with gross and post-insurance costs. You have to ask for the individual claim codes and see how much you get back from medicare then do the same thing with the insurer to see how much they reimburse.
I'm only still buying PHI because it costs the same as the surcharge and hope that it benefits me somehow in the future. If they halved the surcharge and put that into the public system I would scrap my PHI immediately.
Hospital excess should be a fixed amount, and to find out the gap just as the surgeon, "is there a gap fee, how much is it?"
I got no gaps on both my recent surgeries. Only cost me $500 out of pocket each time.
one year of PHI costs you $5000, you need a surgery that costs $10,000, then PHI will only cover $6000 for you.
This is a complete lie that you just made up.
For an (exaggerated) illustration, one year of PHI costs you $5000, you need a surgery that costs $10,000, then PHI will only cover $6000 for you. So effectively you only get $1000 as a benefit of using insurance compared to no insurance. And that's assuming you only had that for a year.
If your maths is so exaggerated to the point of incredulity, then what's the point of this thought experiment? Average PHI policy for singles is a third to half that, and it covers a lot more than $6000 when you need it, my mother's hip was less than $1000 out of pocket for >$20k billable. This was top cover for a senior and was still nowhere close to $5000 annual.
What’s the surgery? What state/region are you in?
You won’t get PHI hospital waiting period waived.
You could shop around as to which surgeon, hospital and whether they have payment plans. Different surgeons do have different fees, as do the hospitals they work with. Depending on the procedure you might be able to save money on not having a GA and doing it as a day procedure, but this completely depends what the actual procedure is.
You can also shop around public waiting lists to an extent depending on where you live and whether you can use someone else’s address. Sometimes one area will have more of a particular kind of surgeon than another. Some districts are more or less strict on catchment. Before an election they tend to ramp up public surgeries eg in QLD there’s an election coming up. Sometimes a new hospital opens and it will have extra staff so lists might be shorter. If you have any medical friends you could ask around as to where they would go for the same procedure.
Also consider whether the surgery absolutely has to happen within 3 months. If it impacts your ability to work it’s a no brainer to just get it and pay out of pocket so it doesn’t affect your income.
Otherwise as others have said, you could look to overseas
Marry someone with long-term health insurace, and ask to be added to their policy with the waiting period waived as an incentive. Make sure to call around to insurers first to get a verbal 'okay' that they'd be willing to do this, some will! You may need to not have a preexisting condition though.
You've got just over a month before you'll have to get the marriage paperwork done.That will certainly make the proposal/marriage vows interesting…
Would be very expensive long term maybe triple the actual cost of the surgery
If you really need it done I'm sure they take cash.
Definitely worth asking. For two of our kids the Obstetricians offered a significant discount on their fees if you didn't have private health insurance. Surprise surprise, when something is subsidised the price is adjusted so you don;t get the full benefit.
No waiting period and do you then plan to cancel the insurance after the surgery?
Hahaha… like this question needs asking…
Can’t wait for OP next post…
“Is there any way to buy a lottery ticket to just win the jackpot? I only want to buy the winning ticket…”
😂
Of course they will cancel once the surgery is done! They have no need for PHI anymore.
and complaining the surgery wasnt going well so they entitle for some compensation
"guys I was just in a car crash and don't have insurance. Can I get it tomorrow and claim"
Even if you could bypass any waiting periods, it may be excluded anyway because it's a preexisting condition
You're SOL
Private insurance in Australia is like nowhere else, as costs are dictated by the government and the service provider.
private insurance does not cover out of hospital medical fees such as consultant visits, scans, tests etc. But Medicare will cover some (or sometimes all) of the fees whether you are public or private.
private insurance only covers whilst in hospital.
Medicare has a schedule fee cost for nearly all procedures and covers 75% of that fee if in a private hospital. The insurance company covers the other 25%. The problem is most surgeons and anesthetists don't go by the medicare schedule fees and charge what they want which means even if you have top insurance cover, depending on the surgery you could be thousands of dollars out of pocket.
Of course this is not what happens in every case, and surgeons like any other business are negotiable. Some reduce their fees for some insurance companies and some will reduce their fees for an uninsured individual who asks.We dropped our private insurance a few years ago, invest what we would have paid in premiums, go public wherever possible, and if need quicker non-urgent work then we go private and pay the difference between the medicare fee and the surgeons fee. Every surgeon has been negotiable.
We are still ahead financially.Just remember that this is how insurance works. On average you should be ahead not paying insurance (whether it's health, car, home Etc.).
Insurance is paying for peace of mind and mitigating the risk of those 1 in 10000 chances where you would end up tens of thousands behind.
I agree with you re. the concept of insurance. The problem here in Australia is that the out of pocket expenses with private insurance can still cost thousands. Remember the insurance company only pays 25% of the medicare schedule fee, not what the surgeon charges.
out of pocket expenses with private insurance can still cost
Depends which package you are on if you on thr very top cover probably max $1k from total $40k but yeah i get what you mean still need to pay. They just greedy
@CyberMurning: I know one person who had oncology surgery followed by plastic reconstruction surgery with a private surgeon with top level insurance cover and was still nearly $15,000 out of pocket.
@BOGOF: ah yeah probably also depending on the type of surgery. oh well.
yep, totally agree thats why i stopped my hospital cover since 10 years ago
That's how PHI in Australia works, but that's not how the insurance in general works.
For example, life insurance, car insurance, home and content insurance, maybe PHI in other countries. Of course you will be ahead by not paying insurance when nothing wrong happens to you. With the usual insurance, you will be in much better position when you do have to make a claim, but that is not the case with the PHI.
For example, with a car insurance, let's say you are paying $2000/year for a $50k car. If you wrecked your car after 5 years, you have paid $10k and you will get a $50k new car.
It is all about the ratio between the premium and the benefits.
Mandatory comment
BikiesJust go to public i mean you can brose ozb must be not live threatening (well apologies if yes, truly)
Ask what can you do while waiting to minimise the pain etc. Could be 12 months max.
Source: my fam member just got the surgery after 11months waiting in public. She suffered most only during the last 2 months. So yeah lucky. Public. All free
I need an elective surgery for a pre-existing condition at a private hospital, within 3 months
Currently without insurance. Is there any options without a waitlist?LOL No, as that isn't how the system works…. You don't go around saving money all these years by not having PHI only to take it out for a couple of months to cover your surgery before cancelling again.
another post asking to scam the system.
saw 2-3 already this month here at ozb something like returning ps5 just because he/she doesnt want it anymoreLOL cheap baby sitting….Buy a PS5 for the kids to use on holidays and return it when school goes back? :)
i remember a mate told me in USA he went to bestbuy get a matress/bed when parents come visiting him and return them after
You'll be paying for it (self-funded). The only question is how much.
Do you have a specialist yet? You can ask their receptionist what you will need to pay, and you can even shop around, then get a referral for a cheaper one from your GP. Any qualified surgeon in the correct speciality may be able to do your procedure, but if it's something complex you will want a surgeon with a focus on your type of problem.
Some surgeons may also be cheaper depending on preference/technique - if they use certain disposable instruments or supplies it may cost more. Private insurance would eat the cost for them usually, but the hospital may charge you for them as you're self-funded. For example, disposable tonsillectomy devices can be between $10 (tip for reusable handheld diathermy) and $320 (Bizact). Your anatomy and health may also determine what they use.
Also you will need to pay the anaesthetist and that can be expensive - the surgeon will not necessarily discuss this cost if you don't bring it up.
Is it a day procedure or will you need to stay as an inpatient after? This is very important to the cost.
You won't get insurance without a waiting period.
If you can't wait a year for private cover to kick in, then overseas may be your best option.
Paying full price without insurance will be very expensive.
depends what kind of surgery. if just dental implants maybe okay but if heart hmm not sure the cost would much different plus factoring the cost to stay overseas maybe with family member go together vs stay here at own house.
and follow up checks as well
you know that insurance only covers 25% of the cost and medicare covers the rest.. so everyone calm down. Insurance is a rip off
Why should you jump the queue while millions pay insurance for years/decades in anticipation of such an event? FFS.