News

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 .

Join the conversation

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

Share your views with other members. 

Want to leave a comment? or .
Read our moderation policy here.
Megan
Megan from VIC commented:

Funny but my partner just went thru a similar story. He was randomly attacked and left with a grade 4 ac joint separation. He had top private health cover, was rushed thru emergency that was 300 to get thru the doors, 5 days in hospital, 500 out of pocket to the surgeon and the 400 health fund excess, and still more to come with the plate having to come out in 3 months, new year another 400 plus 500 to the surgeon. That doesnt include the other bills still to come. Outrageous charging on top of his 1400 a year private cover and 650 to medicare 

Glenda
Glenda from NSW commented:

I am 71 years of age - have been in a Health Fund since I was 15 years of age. There is no compensation for loyalty and I believe there should be something for loyalty. A person who has been in a similar level of Health Fund for a short number of years enjoys the same benefit as I do. 

J and B
J and B from NSW commented:

It's the out of pocket expenses that hurt the most ... my hip replacement left me $8000 out of pocket even with top hospital cover. Am convinced the Private Funds are hoping we can't afford these extra expenses and go via the public system instead ( save them heaps). We all protest when there is an increase in health cover premiums, but you never hear the same outrage about the out of pocket expenses .. health funds advertise 'gap' cover but neglect to mention that its only peanuts (you find that out when you make a claim!.) 

francis
francis from QLD commented:

There is a lot of talk what the surgeons charge??YOU study for twelve YEARS with NO PAY?????????? 

Megan
Megan from VIC replied to francis:

Doctors are paid during their residency and beyond..its only while they are at uni like everyone else there is no pay. They are often given housing, food etc. The argument here is about health funds not what doctors should be paid 

Steve
Steve from QLD commented:

YES I found top cover leaving a big gap. All insurance talk about the gap payment you may have to pay. My question has anyone out there had surgery that the Dr actually took medicare payment and no gap? 

Graham
Graham from QLD commented:

As I am 78 and done a hell of a lot of hard work in my time , cane-cutter for 14 years ,cutting -splitting logs for transoms and railway sleepers , plus - to name just a few and really need both shoulders reconstructed but the end result would see me out of action for ages and ages so I am having to put up with the numbing of fingers , hands etc as I am only in budget health insurance , all I can afford as being a pensioner . Also my Dr said at my age , is it worth it really , my choice .So even though I am a very healthy person I am choosing to put up with those difficulties and save my nest-egg and enjoy my time as best I can , after all , Mum was 96 and her sister [ my Auntie] was 94 and an Uncle 92. , hopefully I have some time yet . Thank You- I am Graham Kelly. 

Kevin
Kevin from VIC commented:

Heartily agree that some sort of action should be taken to ensure that long term contributors to Private Health Insurance do not have the worry of even further hardship imposed with the the sale of Medibank Private. 

Philip
Philip from VIC commented:

Have had a very similar experience in the last 3 months following shoulder surgery. I rang around prior to the shoulder op to get the best deal! I am still out of pocket about $3500.00. Now I have a frozen shoulder which requires another procedure costing over $200 in out of pocket expenses! The gap between private health insurance and what doctors charge is a joke. There appears to be no regulation on what a doctor can charge and while they can charge anything and get away with it we are stuck! 

Helen
Helen from NSW commented:

We recently had an experience with a Hurstville orthopedic specialist after my husband had a shoulder injury. Our first consultation in May $220, requiring referral for MRI. This was followed up with a consultation in July for the MRI result and a Cortisone Injection, consultation costing $100 & Cortisone Injection $75 & advised on our next visit in August we would be seeing another of the practice doctors for the next cortisone injection. This consultation cost $235 & Cortisone Injection $75. My husband was advised he would require another Cortisone Injection on his next visit. When we complained of the cost of the last visit especially considering the consultation cost was more than our original visit in May we were advised we should of gone to our public hospital if we did not want to pay these fees. This practice does not offer any Pensioner or Senior discount. Needless to say we cancelled the following doctors appointment & on our next visit to our GP will advise her of their dodgy practices. Regards Helen 

Alfred M
Alfred M from QLD commented:

OK, I have top Private Cover, but as you say, all the additional costs. The Specialist wants to see you two or three times anything up to $200.00 a pop, Blood tests in Private are not free, X rays, a new one I have come across is "Booking Fee" $100.00, it just never ends. As you say the health funds go up, way more than CPI but repayments don't come anywhere near the costs we have to pay. My wife and I are both 79Year old Pensioners. We usually can only afford to have something done about every two or three years, we have to save as mush as we can for the next op. 

Comment Guidelines