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NewsHow a Dodgy Shoulder cost me thousands and what it taught me
How a Dodgy Shoulder cost me thousands and what it taught me

How a Dodgy Shoulder cost me thousands and what it taught me

stickingup-dashAs a father I feel the only responsible thing to do when it comes to health insurance is have the top private health cover.

So my wife and I decided to make some sacrifices and pay a premium with one of the large insurers… we call it paying for peace of mind.

We’ve been doing that for many years, and it seems the only reward in recent times has been to see our premium increased by around 9 per cent a year for no extra cover (around 3% more than the average).

But with two beautiful and boisterous young sons we decided not to take any chances.

Little did we know it would be Dad who’d be making most of the claims this year!

I have recently had shoulder surgery on my rotator cuff, which I’ve learned is called ‘old man’s shoulder’. (Hang on. At 58 I’m not that old, am I?)

“Just bad luck,” said the Doctor, “You’ve worn them out, and after we’ve fixed the left one we will have to operate on the right one”.

So it was off to the specialist, more money, mostly out of my pocket. He wanted x-rays, an MRI and an ultrasound – so even more money, again most out of my pocket.

Fortunately, my two nights in hospital for the surgery were completely covered. But then I got the bills for the surgeon and the anesthetist … you guessed it, more money out of my pocket.

The injury has so far cost me directly more than $4000, above and beyond the amount we spend annually on top cover. I am still in a sling, and now I have six months of costly physiotherapy to look forward to.

Don’t get me wrong. I am grateful for the cover, and the great medical service available to enable me to return to normal in a relatively short space of time.

And I’m not alone – plenty of people go through this experience or something like it every day, and not all can afford top cover.

But, ouch. As if we don’t have enough bills already.

And as a fortunate individual who’s enjoyed good health all of my life (read no claims) this has come from nowhere.

But the reality is that out-of-pocket health costs are higher than they have been for a decade, according to the Australian Institute of Health and Welfare. And this is happening despite the fact most of our health insurance premiums have doubled in about a decade.

Here at the FiftyUp Club, we know health insurance premiums for the Over 50s rose by roughly 1.5 times the federal government’s published national average. That’s why we launched a petition asking for more detailed disclosure of premium increases, which was signed by 13,000 members and which I delivered to the Federal Health Minister earlier this year.

We’ve also asked the government to consider the impact of proposed co-payments on GP visits, X-Ray and Pharmaceuticals given the already-soaring healthcare costs of older Australians.

At least the controversial co-payments appear to have been ditched for now (our information is that they are buried, which is a good result for all Australians – but particularly for those over 50 on fixed incomes).

Now that the federal government is preparing to sell off Medibank Private, we’ve launched a campaign to ask that they do more to ensure the sale doesn’t ratchet up healthcare costs yet again.

How much will it cost to fix an old man’s shoulder a decade from now, when you add up the cost of top cover and the gap payments?

How will an average salary-earner afford it, let alone a pensioner?

That’s why we think healthcare costs are the big barbeque stopper for baby boomers and older Australians. And that’s why we’ll keep fighting with our 100,000 members to make it clear to businesses and governments around the country.

Originally posted on .

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How a Dodgy Shoulder cost me thousands and what it taught me

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jennine
jennine from NSW commented:

My friend had a knee reconstruction and as mentioned had several thousand $$$ in out of pocket expenses for the operation. Health is expensive & the fact that the surgeon had a $500k Merc , Top cover ??? what for check the health funds annually & pick a plan that will suit your circumstances & budget at the time 

jennine
jennine from NSW commented:

After reading these tails of woe and my minor experiences with the private insurers , ooooooooooooooold age sounds like a hole in the head - not good 

Melani
Melani from NSW commented:

Melani from NSW , so glad that you are on our side. Yes health insurance is one topic to tackle . 

Florence
Florence from QLD commented:

We are pensioners and have been paying into Health for 58 years and we still have to pay heaps of money to get anything done. As of now we have been reasonably healthy and have only had to have our cataacts done as well as some sun cancers cut out. I had mine done in the surgery and didn't cost me anything which was good. We are keeping it up as when we need to have something done we can get it done as soon as possible even if we have to sell our house if it was necessary. there are too many people who can afford to pay for Health Benifits using the public system so it should be means tested. 

Leonie
Leonie from NSW commented:

Recently received a 'quote' from a specialist for an operation so I phoned Medicare and my health fund. Was disgusted to learn that between them they only pay 85% of the scheduled fee, in most cases Medicare paid 75% and my health fund made up the rest. What the heck am I paying top health cover for. Private health funds should be paying the gap between Medicare and the specialists bills 

raymond
raymond from NSW commented:

My wife and I have been in private medical fund for the past forty years now retired and after a shoulder operation in private hospital and out of pocket $2000 .In and out within 24 hours. Attended local public hospital on several occasions with heart condition admitted and attended by top specialists no cost. About to give private fund the flick and get on with life sick of being duded. Bet minority groups not paying funds 

Brian
Brian from NSW commented:

Yes frightening to contemplate what is ahead in health costs. 

Edith
Edith from NSW replied to Brian:

Be careful I changed funds thinking i had most of the same cover but with a saving and now find that some of what i was previously covered for i am currently not. Only find these things out when you nee to claim. 

Suzanna
Suzanna from NSW commented:

I had a routine D&C & polyp removal recently ... the out of pocket costs are $1,500 for the surgeon & Lord knows what for the anaesthetist (haven't had the bill yet). I pay $154 to my private health fund per month & have barely claimed in years ... their rebate on the recent surgery gap was $77! 

Laurie
Laurie from NSW commented:

I totally agree. I have to have a knee replacement in two weeks time. I will be $4500 out of pocket and paying top health cover??? Why??? 

Linda
Linda from QLD commented:

I totally agree. I am single and in the low income earner. My health cover is $93.00 a fortnight. A lot of money. Am going to a specialist regarding a future knee operation and the first visit was $180 and got back $73. Operation is $750 and I get back $370 

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