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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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Narelle
Narelle from QLD commented:

My gap for my shoulder is $3500. But I will pay it. I have no option. Seems so much when I'm in full cover for hospital. 

Penelope
Penelope from VIC commented:

I have had top cover also and need some elective surgery that could be done as a public patient but waiting lists are long after seeing the specialist day case out of pocket expences will be $5,000, that for the surgeon and anaesthetist. Truth is on a pension I cannot afford to have it and why am I stretching myself so hard to pay $82 every fortnight from my single pension???????? I must be nuts!!!!!! 

Beverley
Beverley from NSW commented:

Well said John, I am very worried too. I am 73 with a well-worn knee joint and my insurance has an 8% lifetime loading on the premium, and as I have recently stopped working I can ill-afford the premium AND the gap of the specialist's fees. 

Michael
Michael from NSW commented:

Been through same ,no longer covered can't afford the Gap 

Onville
Onville from VIC commented:

I had a recent key hole operation to remove my gall bladder due to having gall stones, a simple procedure, meant to be an overnight stay, wrong !!! due to complications and billiary peritenitus I was in hospital very ill for two weeks and in pain, but then when I recovered, the pain started all again with the numerous out of pocket bills which began arriving, due to no fault of my own, even being in private health for many years didn't mean a thing when it came to the charged fees against the scheduled fees and the benefit refunded, I end up like John with thousands of dollars out of pocket due to Scans, Anesthetists, Hematology etc etc, to me its one big rip off, that you have no control over, when you are at your most vulnerable and fighting for your life. Private health insurance is not what it should be and needs to be severely over hauled so that you receive a 100% back of any fees charged when you have top hospital cover, they should reimburse you with the full amount after medicare has reimbursed their portion. Seriously considering opting out and going public in the future. 

pauline
pauline from VIC replied to Onville:

I totally agree with you. I had a stroke and was in one of vics. best hospitals Cabrini. My costs for being in there for four days and Donvale rehab for 6 weeks left us thousands out of pocket and we had top health cover. Then 5 years ago my husband was in a public hospital with acute Pancreatitis and in ICU as a public patient for 3 weeks with gall bladder removal and cost us nothing. He was admitted instantly and they didn't want to know about our private cover. So I have discontinued private h/c since I no longer work and hope for the best? 

adela
adela from NSW commented:

Adela Grafton. I am at present wondering if I will go ahead with colonoscopy privately or opt out and go public. Have been an NIB member for years but miss out on the latest medical from 50up club. In process of pricing whole thing and am worried after reading the comments. May leave private as I am a pensioner, can't afford cover and expenses. 

John
John from VIC commented:

The real problem is that we have a top public system, but 17 years of government squandering good money on supporting private health cover have dwindled away the services the public system is able to provide. I am having surgery on my Right Rotator Cuff, right collar bone and right tendon in 3 weeks time at a public hospital and I am glad for the public system, next year I will have the same done to my left shoulder. I am 58, I believe in Medicare and the government should stop propping up a failed private system. The private system should only operated as an ancillary to Medicare, not compete with it and private health funds should only be allowed to cover top ups to the medicare system if you choose to opt into private rooms or for treatment outside of the public system. 

John
John from NSW commented:

I too like John have experienced much the same history regarding private health insurance, I became a member some 70 years ago paying maximum cover, had no major illness until I was in my 70's and then required open heart surgery. That was 10 years ago. All this still cost me about $6000, out of pocket expenses___But the week in a private room was great although costly. 

charles
charles from VIC commented:

Years ago back in the 1950 if you went to a public hospital you had to pay something. Let these people pay the $7 not the ones that all ready pay in to a hospital fund and also their Dr charges a fee , and don't suggest going to one that does not charge ,as this is out of the question if you do not drive and are in your 80's 

Cheryl
Cheryl from NSW commented:

I was born in 1953, six children; my family poor as they were had private health insurance. When I started work at 16 I took over my own; I could afford it. No medicare then; you went to the doctor took it to the fund you got money back. Medicare ruined everything. Have had private cover all my life and like John I never stop paying out. 

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