Medicare

[Norwester]

Hi all,

Been a lot of discussion lately re Medicare, NDIS etc etc. Just thought I'd share some recent experience.

Over Christmas in Perth I had the pleasure of having a minor paraumbilical hernia ( just think of Alien and you'll get the idea). Anyhow no big deal, quick bit of internet diagnosis and then confirmed later by both GP and Surgeon.

Other than being an active financial contributor to both Medicare and private health insurance I haven't been to the doctor or had anything else other than Mine Health Clearances or work related medicals for about 10 years now. So in effect I have no family GP and the matter gets further complicated by living in both Perth and Melbourne and a looming 4 week trip to the USA......

So what does one do in this day and age?? Look on the internet of course..

Picked out a surgeon that seemed fairly decent and reasonably priced. After speaking with his receptionist, she booked an appointment for when he was back from holidays (3 week wait) on the proviso that:

1) I got a referral
2) Turned up on the day with $200 cash.


Referral was through 24 hr Bulk Billing clinic so no charge there, but they of course were most insistent that I use their prefered guy. But in the end they did what I asked and confirmed my own diagnosis and gave me the referral to who I wanted.

Anyway long story short it all got taken care of (very professionally I might add).......and today I went down and sat with the masses at the Medicare / Cetrelink Office to claim back some cash.....

Initial Consultation > Charge: $200, Sch Fee $85.55, Benefit $72.75
Final Consultation > Charge: $100, Sch Fee $43.00, Benefit $36.55

Add to that the bits you can't claim from anyone:

Surgeon $500
Hospital $200
Anaesthetist $150

Now remember.........this was just minor surgery with one night in hospital. How the hell does anyone having something major done, stump up the up fronts and gap cash......

This system is knackered. You are compelled to pay medicare, penalised for not having private health insurance and then still have to pay........

So anyhow where do you think the issue lies?

The Charge?
The Scheduled Fee?
The Rebate?
Me?....


Ciao

Nor

 

[geoffw]

A friend of mine died from breast cancer. But the husband was up for something like $300k out of his own pocket for the years of treatment. Fortunately he had a high flying job and could afford it. (The accountant who absconded with $250k from his trust fund is another story).

There is the option of going to a public hospital, with no choice of doctor and all sorts of other downsides- especially if you are going to have "elective" surgery- I think getting rid of pain or being able to walk are not necessities.

 

[Perp]

How the hell does anyone having something major done, stump up the up fronts and gap cash......

This system is knackered. You are compelled to pay medicare, penalised for not having private health insurance and then still have to pay........

So anyhow where do you think the issue lies?

Firstly, I would have thought you could claim surgeon, anaesthetist, etc... were you a public or private patient, in a public or private hospital?

(I know that makes a difference, but it's hellishly confusing.)

Secondly, a significant issue is that the Medicare scheduled fees, 20 and 30 years ago, were pretty close to what doctors actually charged (and AMA recommended fees). Over the years the government has put up the Medicare scheduled fee far too little - IMHO - such that the AMA fees are now often double or more the Medicare schedule fee. That's why bulk billing has become much less common, because it's close to doing charity work, whereas there used to be little difference between bulk-billed and non-bulk-billed work.

 

[Peter_Tersteeg]

Serious out of pocket expenses for major surgery is what trauma insurance is for. A good friend was recently diagnosed with breast cancer and would have trouble with many of the costs as they litterally live from one pay packet to the next.

Fortuantely she's got good insurance has had a lump sum payment of $60k to help.

 

[cimbom]

I had surgery in January this year. I travelled to Canada to have it because it was cheaper (inc flights) than having in Australia and the doctor was internationally renowed. In Australia, it would have cost me about 12k. I had it done over there for 7.5k. I pay 2k per year for hospital and extras cover and they would not have covered a cent. I think I would have got a measly few hundred from Medicare. I didn't want to take it out of my savings so I put it on a credit card and I'm paying it off at present.

 

[BayView]

Now remember.........this was just minor surgery with one night in hospital. How the hell does anyone having something major done, stump up the up fronts and gap cash......

This system is knackered. You are compelled to pay medicare, penalised for not having private health insurance and then still have to pay........

Ciao

Nor

We saw this first hand when living in the USA (wife was on Nursing Contract there for 3 years).

Medical bills are the biggest cause of bankruptcies in the USA.

We like to follow the Yanks in almost everything, soooo................

 

[HiEquity]

So anyhow where do you think the issue lies?

The Charge?
The Scheduled Fee?
The Rebate?
Me?....

It's you.

As geoffw said, if you had just run the gauntlet at a public hospital, it would very likely have all been pretty close to free. The problem was that you wanted to pick your surgeon. The public system doesn't allow that - if you choose the surgeon, you pay. Which seems fair enough to me.

If you want such luxuries, you need private health insurance.

My wife recently went through a thoroughly exhaustive six months of tests, chemo, checkups and related palaver. We fortunately had private health insurance. Got to choose our specialist, get treated in a lovely hotel-like private hospital, get scans done etc etc. For all that time we might have been out of pocket around $5k or so (I wasn't counting TBH) for consultations in the specialist's rooms (which you still have to pay - in-hospital consultations are free) and the gap in the cost of the medicines (often poisons - ie chemo chemicals) which nobody fully covers but Medicare takes the vast bulk of the cost. Total cost of the whole treatment would have been well north of $100k (probably $200k - I haven't fully checked the private and Medicare benefit statements - there are so many of them).

Would have been a similar cost in the public system but we wouldn't have got to choose our specialist and in our case I firmly believe this ability saved her life, for reasons I won't go into here. Ours was one of those rare cases of professional disagreement between specialists and the stakes couldn't have been higher. I believe we made the right choice and the more we have learnt the more that view has been reinforced.

Having recently been through this washing machine, I believe the system actually works very well and balances universal health care benefits with freedom of choice and the ability to insure such if you wish.

 

[Jake D]

I had the exact same procedure early last year. My out of pocket expenses were something like:

$30 for my favourite GP to consult and write me a refferal
$160 for initial ocnsult with surgeon. (I can't remember the breakdown of cash paid/medicare refund)

$0 Hospital/Surgeon/Anaesthetist. Overnight stay, meals etc. Included. No private health cover. What was special about yours that the public health system wouldn't cover it?

$0 follow up consult with surgeon.

 

[MrsChatz]

Ankle fracture cost more than $7000 last year - with PHI

I had a navicular fracture repaired a year ago today. There was no question of waiting to go public - likely 2 + year wait and I couldn't walk. MRI, CT scan x 2 and bone scan undertaken beforehand (only MRI bulk billed) surgeon's fees were $4800, of which $385 ish came back from Medicare. Then there was the anaesthetist, the surgical assistant and the vascular specialist who came to tell me about injecting anticoagulants. Overnight hospital stay - we only paid our excess of $500, cheapest part of the whole ordeal. Otherwise PHI only covered gap between scheduled fee and Medicare rebate for in-hospital services - grand total of about $400.

I am fortunate that I was able to have my surgery at all. Yes, I was able to claim the 20% above $1200 on my tax but that didn't amount to much.

 

[westminster]

If you don't want to rely on the wait times for public - which would have been difficult for you in 2 states and needing to travel soon then the only real option was to stump up the cash. I think you did quite well to get away with spending so little.

DH didn't use his private health insurance at all for 12 yrs but was part of our family cover with HBF. Then ...... promptly racked up about $120k in surgery over 2yrs. He's now got a fused disc and an artificial disc in his back and boy am I glad that both his neurosurgeons are on the HBF Gap Cover plan as all his hospital stays have cost us zilch.

Together with a DD5 who has a paed, development paed, OT, Physio and speech therapist, DD7 who has glasses, DD14 with glasses and orthodontics and my own physio and glasses, we are heavy claimers. Our $4k a year on health insurance is a bargain compared to what we claim

 

[weg]

So anyhow where do you think the issue lies?

The Charge?
The Scheduled Fee?
The Rebate?
Me?....


Ciao

Nor

If you've gone private then this would be your gap.

I'm a little confused as to why Medicare paid for some of this if that's the case though??

If you use the private system as a Medicare patient you have similar gaps (excluding hospital which Medicare doesn't cover) so either way you pay.

Only in the public hospital system are you guaranteed no gaps.

 

[Perp]

I'm a little confused as to why Medicare paid for some of this if that's the case though??

I think that Medicare still covers consult fees in specialist rooms, whether you're public or private.

 

[weg]

I think that Medicare still covers consult fees in specialist rooms, whether you're public or private.

OK, didn't realise that. It explains it then.

 

[Perp]

OK, didn't realise that. It explains it then.

They didn't used to - only those with private health insurance could claim specialist's fees - but it changed a fair while ago, maybe 10 (?) years ago.

 

[whiteduck]

Private hospital cover pays for the hospital stay only. Thats why it's called hospital cover In the private system If you get seen by anyone - surgeon, physician, anaesthetist - they will all bill you separately. You will have to pay the gap fee between medicare and the real cost.

As someone already pointed out medicare rebates have not kept pace with inflation. If these rose to represent true cost the government would be bankrupt and or we would be all paying an extra 1 or more percent medicare levy.

As I see it private cover is good to have for non emergency ie elective things where you would wait for a long time for in the public system. Also for being able to choose the specialist you want.

As an example you stuff your knee playing touch footie - you need an arthroscope - you will will wait months or possibly years for this. Or non urgent colonoscopies, or cataract surgery. Or if you are a depressed and need some respite - take your chances in the public mental health system.

 

[big_head]

Doesn't Medicare pay 75% of the schedule fee, then private pays the remaining 25%. You then pay the gap. This is of course as an inpatient, outpatient isn't covered at all by private, but it is with medicare.....

 

[Tony3008]

Doesn't Medicare pay 75% of the schedule fee, then private pays the remaining 25%. You then pay the gap. This is of course as an inpatient, outpatient isn't covered at all by private, but it is with medicare.....

I had to have a couple of difficult teeth removed in day surgery - needed to be put right out. Anaesthetist bill was $400. Apparently the book price is $200, Medicare paid $150, Medibank $50 (I have health cover with all the extras) leaving me to pick up the other $200. I do wonder what I am paying for. It's not like I chose an expensive anaesthetist - it was the surgeon's choice.

 

[china]

Hi all,


Anyway long story short it all got taken care of (very professionally I might add).......and today I went down and sat with the masses at the Medicare / Cetrelink Office to claim back some cash.....

Initial Consultation > Charge: $200, Sch Fee $85.55, Benefit $72.75
Final Consultation > Charge: $100, Sch Fee $43.00, Benefit $36.55

Add to that the bits you can't claim from anyone:

Surgeon $500
Hospital $200
Anaesthetist $150

Now remember.........this was just minor surgery with one night in hospital. How the hell does anyone having something major done, stump up the up fronts and gap cash......


Nor

Your hernia repair would have taken the surgeon anywhere between 30 minutes to 60 minutes of his time. He would have pocketed your $500 (gap) plus a fee from your health fund ($400) - not a bad hourly rate. Now if he is hard working and has a busy practice, he could easily do eight of these a day. The system is clearly working well for surgeons.

 

[wylie]

Here we go again.....

 

[D.T.]

Your hernia repair would have taken the surgeon anywhere between 30 minutes to 60 minutes of his time. He would have pocketed your $500 (gap) plus a fee from your health fund ($400) - not a bad hourly rate. Now if he is hard working and has a busy practice, he could easily do eight of these a day. The system is clearly working well for surgeons.

Are you a surgeon and / or a specialist?