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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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Someone
Someone from VIC commented:

Totally agree! We to pay high health insurance insurance premiums only to be well out of pocket when my husband had his shoulder done, however if we used the public system it would be totally free! 

Nerrel
Nerrel from NSW commented:

I had a broken wrist two years ago. Went to our local emergency within public hospital, which is connected to a private hospital. Given pain medication, x-ray straight away and off into public ward. Dr visited me re operation. Advised under public could be done next day, under private two days wait. I stayed in public, and received the best of care. My wrist was very badly broken, having a plate & four pins which will stay in forever. I'm really wondering why I am still paying for private health cover. With NIB paying top cover $338 per month. Like the other lady who posted here, where is the loyalty from them to us when we've even insured with them for a very long time. I would have liked hearing with the recent deal struck by this club with NIB if you join they give you an eftpos card for $250, how about that for those of us in this club who are already members. 

Dianne
Dianne from QLD commented:

I would like Medibank Private to remain in the governments hands. I like many others cannot afford increased healthcare costs if the sale goes through. It is outrageous the amount it costs for out of pocket expenses before & after surgery by specialists, anesthetist, doctors etc. Thankfully all except $250.00 was covered by the hospital. I wrote a letter to Canberra re the out of pocket expenses & the response I received was the government has no control over what doctors / specialists etc charge over the scheduled fee. I tried to claim out of pocket medical expenses on my tax only to be told because I didn't claim anything last year I am not eligible to claim this year. It seems the goal posts are always moving with what can & cannot be claimed. My private health insurer told me that they would love to be able to give back more money but are restricted if it is covered by Medicare or the doctor does not have gap cover (the specialist here did not have gap cover). I would like to see better returns for the amount of money paid into health insurance plus the Medicare levy. We have paid a lot of money into health insurance over 45 yrs without making claims & I was really annoyed with the little amount I received back with top cover. Health insurance premiums should be frozen until there is a complete overhaul of the healthcare system by the government looking into outrageous out of pocket expenses. Dianne 

Eric
Eric from QLD commented:

I'm sorry, but I disagree with your whole attitude. I had been a subscriber to private health insurance some years ago, but got a call up from Public Health for a total hip replacement after only a 6 months wait. That happened, but then a need for a revision of the op 4 years later - no hesitation - good result. I've since had a Bone Marrow Transplant through the Public Health System, with great results. I am aware that others who have undergone such a procedure invariably end up in the Public facility, as the Private sector does not have the staff, the infrastructure or the overall capability to deliver. So if you need/want quick attention, with no potential complications 

Marylyn
Marylyn from QLD commented:

I am with NIB after a recent Colonoscopy which was clear (my excess of $250 was payed for day surgery) I have received a bill from QML for $280.00. NIB have payed $27.00 !!!!Medicare $83.00 I am really angry. I am on an aged pension when I visit my local QML for blood tests I am bulk billed . 

christine
christine from NSW replied to Marylyn:

I am in a fund but had to have a Colonoscopy. decided to use the public hospital. didn't cost me a thing rethinking my health insurance 

Alfred
Alfred from NSW commented:

Mr Mangos, I totally agree with your assessment of the unreasonable cost increases for private health Insurance and the hefty extra out-of-pocket-expenses that Pensioners have to live with. I just sent a Message Comment about an other issue regarding Private Health Insurance that Pensioners face, who frequently wish to travel for extended periods overseas.... Please read my comment and I trust that you will be able to find some resolve to this issue through the 50 up club. Thank you, Al 

Chrissie
Chrissie from VIC commented:

I totally agree with your comments. If we pay top cover for health insurance, why are we not covered for all expenses? It seems anaesthetists costs are the most expensive and, while they are in the business of making sure we don't die on the table, why do we pay top cover only to be confronted with "out of pocket expenses"? Surely "top cover" should mean we do not get slugged with extra medical expenses. The way it is set up at the moment doesn't make sense. Chrissie 

Gordon
Gordon from NSW commented:

At 70 I am due for hip and knee replacements - probably four separate operations over time. I have been putting them off because of the considerable out of pocket expenses I am going to incur. Like John Mangos I have had relatively few and only minor claims in over 50 years of fund membership. Gordon T (Belmont) 

Megan
Megan from VIC commented:

I want to add that Gap Cover is a rort, the health funds offer it but its not up to them if you get it, only the surgeon can authorise it, and he can pick and choose who he gives it to, its not guaranteed even if the surgeon is on the health fund list. I know this, cause it happened to me and I have yelled about this scam but no one listens. 

John
John from VIC commented:

Hi John I am 65 and recently had a replacement knee operation and spent roughly $4000 out of pocket expenses for surgeon, anaesthetist , Xrays before operation and also when I was in bed as an inpatient and...... would you believe, an account for pain killer tablets they gave to me when they sent me home. I am on highest hospital cover and the hospital was great as far as their services were concerned. However, I have to go back to see the surgeon soon and to have more xrays that will cost me more. I forgot........My referring GP also costs me $72 a consultation of which I get around half back! I thought originally that I would be able to claim something back on taxation but apparently that method finished last year. If I had been in a public hospital I would not have had to pay a cent. Something is really wrong! Cheers everyone lol John from eastern suburbs in victoria 

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