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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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Julie
Julie from QLD commented:

Same with me, i need cataract surgery and my out of pockets expenses are going to be $4000, my top health insurance will only pay $2000. I am seriously thinking of cancelling my private health insurance. Why is this so? House insurance covers everything if my house burns down? 

Sharon
Sharon from VIC replied to Julie:

I have recently had cataract surgery on both eyes and my out of pocket expenses were $7400.00. My health fund covered nothing and i got back $500 per eye from Medibank. After so many years of top private health cover, just doesn't seem fair to have to pay so much for something that takes minutes to do and is necessary if you want to be able to see. Seriously considering getting rid of private health. 

margaret
margaret from NSW replied to Julie:

You are in the wrong country. You are possibly the wrong skin colour.I believe a $25 donation will pay for someone overseas to have that op.Oh how I love The Far Horizons club with its'mission statement "The farther they be, the dearer they are".Again I ask When will we get a breakdown of these ridiculous charges? 

Remo
Remo from QLD commented:

I have just been presented with a large premium for next years cover for private health insurance which made me gasp. Specialists, surgeons and anesthetists all charge what seem like exorbitant rates, however they might argue that their fees are comparable with other industry leaders, politicians, lawyers and company executives, which may, or may not, be a valid argument. There is also a very high level of technology behind all medical procedures; the capital costs of which has to be paid for by the medical profession and hospitals. Furthermore, medical treatments and procedures are much more advanced now, and have greater success rates than ever before. All this complexity comes at a price which has to be paid for by either governments, health cover providers, or individuals. So what choices are there? I can't see society willing to scale back the level of medical care demanded nowadays. So do we increase taxes so the government can contribute more. Increase private cover premiums, or let individuals pay more out of pocket? Do we legislate that medical professionals cannot charge more than a predetermined fee, and who determines that fee? 

jennifer
jennifer from NSW commented:

Much thanks to 50 up club two days ago I joined Nib after being with HCF for so long I can't remember.originally I joined with full hospital cover plus top extra cover,but as the years went on and premiums became out of reach I ended up being for only hospital cover. Now though with NIB I am covered for full hospital cover plus top extra cover for the things I need such as glasses teeth and physiotherapy etc for less than I was paying with HCF am so happy.on top of that I believe that 50 Up Club is giving me a present.never had anything given to me in my life.Thankyou. Lastly let me say John with your operation you have become one of us.congratulations. Jenny shaw. 

ian
ian from NSW commented:

we have been in private health cover since the birth of our first baby (1969) and have only used it about 6 times. over the years we have kept paying our premiums until we decided to pay an excess to reduce the cost. then my wife had to have knee surgery (keyhole) about 18 months ago. so I dropped her off on the day of the op. filled in all the paperwork paid the excess and drove home. I only had time to make a cup of coffee when the hospital called to tell me to come and pick her up. this was a total of 4 hours. after everyone got paid we ended up $1616 out of pocket and my wife's knee is no better than before the opp. the gap and the cost of insurance (which keeps going up every year) has forced us to cancel our insurance and take our chances...ian nsw 

jennifer
jennifer from NSW commented:

Much thanks to 50 up club two days ago I joined Nib after being with HCF for so long I can't remember.originally I joined with full hospital cover plus top extra cover,but as the years went on and premiums became out of reach I ended up being for only hospital cover. Now though with NIB I am covered for full hospital cover plus top extra cover for the things I need such as glasses teeth and physiotherapy etc for less than I was paying with HCF am so happy.on top of that I believe that 50 Up Club is giving me a present.never had anything given to me in my life.Thankyou. Lastly let me say John with your operation you have become one of us.congratulations. Jenny shaw. 

frank
frank from QLD commented:

How true John,The major problem lies with the exorbitant fees over the recommended level , charged by specialist,this need looking into.Frank. 

Chris
Chris from QLD commented:

After being diagnosed with prostate cancer, I found myself in the invidious position of having to go "doctor shopping". We have paid for top cover all our married lives but the gaps of SOME doctors are extraordinary. I say SOME because I found doctors who were able to remove my prostate without paying large gaps. I had wonderful care and was only out of pocket for hospital stay excess. I did however find one doctor who was an absolute criminal and charged an exhorbitant amount after quoting a tenth of the final bill but he is not the norm. Also, Paul from NSW is right, Medicare schedule fees have NOT been increased for some medical practitioners in many, many years. The rebate for a chest x-ray is the same today as it was in 1999, that's right, most radiologists medicare rebates have not been changed in FIFTEEN YEARS. I know that once we finally retire we will not be able to afford private health insurance any longer. 

Edward
Edward from NSW commented:

You used to be able to make a claim on your tax at the end of each financial year refunds over an amount deemed by the ATO for the proportions not covered by Medicare, Health Funds, Chemist Prescriptions etc, but of course that has changed, not only has the non claimable part been ratcheted up but you have to make a claim every financial year & if you miss having a claimable medical or related cost that does not go over the non claimable amount, then tough luck you are no eligable to make a claim after that year so everyone will be out of pocket for the full amount. The unforeseen result is that to keep yourself eligble, folks will be encouraged to have unecessary surgery & claimable items to keep them at a level where they can make a claim every financial year, & for pensioners with high cost medicines, surgery & related items, they just don't give a damn about them, & as Raie (below) have large related expenses that don't become apparent till you are a lot older probably would be unable to get assistance or relief from tax returns even though it is only a lousy 20% of the amount, less the threshold. There are still many pensioners & Self Funded Retirees that still have to do Tax Returns out there & they should be entitled to assistence even though some polititions think they are getting too much, I would like to see them live on a OAP, it would bring them back to the real world they keep talking about but will never experience. 

Christine
Christine from NSW commented:

Recently my husband had to have his knee replaced. afet ,any years of payng Top Hospital and private cover we are still at least $5000 out of pocket. We do still work, but hibby is a casual and this amount has certainly been difficult to find. However, having Private cover meant we could choose his surgeon, didn't have a long wait and was able to go to a rehabilitation hospital after the operation. It would be nice to feel that we could get more back. Maybe scheduled fees need revising. Also the premiums seem to be going up at an alarming rate. 

Paul
Paul from NSW commented:

Unfortunately, GAP is the result of Government failure to adjust medical benefit payment for Medicare covered procedures and the lack of competition to control Doctor's Fees. 

margaret
margaret from NSW replied to Paul:

I am happy to blame governments for any and every thing including today's rain. Never-the-less medical charges are often so excessive that even I can understand the government saying "Not on" Easy to scoff when some one doing low paid, yet necessary work asks for an extra 40 cents per hour however the huge claims made by those further up the food chain do not attract the same concern. 

Paul
Paul from NSW replied to margaret:

Government last adjusted payment for GP visit in 2004 from $31 to $36 dollars; currently AMA recommended rate is $73. Not hard to see who is getting squeezed, who is driving costs and who is not listening; and yet GPs are the most cost effective means of maintaining health and avoiding the expensive costs of ill health. Cost escalation in specialist care and hospital care is heading for the stratosphere, fee competition or any form of fee regulation or oversight is non existent. 

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