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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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Stephen
Stephen from QLD commented:

I see your point 100% and I constantly here about the so called gap! It must be the specialists etc. charging way above the recommended rate or the health insurers have reduced their % of cost. I personally think the specialist especially surgeons and anaesthetist seem to charge exorbitant rates and get away with it. I have heard from friends and others who have cancelled their health insurance and now rely on the public health. Two of them recently had Knee and hip replacements and only had a 6 month wait. It cost them absolutely nothing! If you have a chronic illness you are straight into the hospital at the public expense. After being insured at top hospital and top extras for over 30 years I now wonder if it Is worth it. Public health costs the gov billions of dollars we know, but they are not doing enough to curb the increase in charges. I know specialists have done years of training etc. But I look at recent job adverts for eg an Obstetrics and Gynaecology specialist required, start at $2000 a day with additional support and travel expenses and accommodation paid for, no wonder our private health funds have a cap. What would the gov do if we decided to quit our private health and go public. As far as co-payments go I don't have an issue, my wife is a medical receptionist and she is constantly astounded at the sheer abuse of the system, People coming to the doctor for the smallest ache or slight headache even a simple cold just clogs the system she says it is common practice to expect up to 30% of patients each day at her bulk billing surgery really didn't need to come. However they receive 10 minutes with the doctor and we the public pay. It's a catch 22 I know however for me $7 is not too much. But how do we curb the abuse? 

Raie
Raie from NSW commented:

During the past 6 years, my husband has had 2 shoulder replacements plus a 2nd operation on the first shoulder requiring a bone graft plus 2 knee replacements. We are covered fully for hospital costs but find ourselves out of pocket 3 to 4 thousand dollars each operation. Prior to these operations we rarely made a claim. I would hope that one day soon the health funds would reduce the premium on an annual basis if a claim was not made during that year. 

Kim
Kim from NSW commented:

Yes I have been paying for Private Health for over thirty five years, yes have claimed quite a lot(chronic condition)but have also paid out of our pocket-hundreds of thousands . .If you have private cover then that should be that, including Dr's, Scans, ex-rays, blood test etc (Which is where I have paid most of my hundreds of thousands to). If you pay Private then that is all you should pay. 

Margaret
Margaret from NSW commented:

How much would it have cost without your top health cover? 

Tricia
Tricia from QLD commented:

Private health insurance is just another example of paying huge amounts of money for very little return. We used to be able to claim so many more things once. Where did all that cover go? 

Penny
Penny from NSW commented:

Out of pocket expenses are seriously crippling when a family member needs medical attention. My daughter has a number of conditions, all of which require specialist attention and on-going medications. They cost an average of $10,000 per annum over and above her health insurance premiums. How is a young married Mum expected to carry such a load? Free health care? Not for us. 

Gary
Gary from NSW commented:

This has been exactly my point for years. The cost of Private health cover was rediculous then and is even worse now! We were in a health fund but got little in return in comparisomn to the premiums after the "out of pockets" hit us. The annoting thing was that most bills had to be presented to Medibank first and then a small part of what was left was paid by the Health fund. We got out. 

Kevin
Kevin from NSW commented:

my Insurer pays the AMA rates so my recent knee replacement cost me zero. 

Bruce
Bruce from NSW replied to Kevin:

Can Kevin tell us which Insure that is please...! 

Maxine
Maxine from VIC replied to Bruce:

Yes Kevin, please tell? 

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