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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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Anne
Anne from ACT commented:

I would like to see 100% cover and a return to the old system of Medibank - you either insure privately or a percentage of income is collected for public health insurance. At the moment anyone insured privately pays huge amounts when combined with compulsory Medicare and gets very little in return money wise. The only comfort is that you can get quicker and possibly better treatment. 

Judi
Judi from NSW commented:

Hi John, yes I agree. I remember the days when Health Cover covered all costs. I'm now on a Pension only and due to high ongoing medical costs (including life saving medications not on PBS) have no spare cash which prevents me from seeing Specialists as cant afford the $170 over and above Medicare wanted by some. It recently took me a year to save for a visit, as most only see you in Private rooms these days, not a hospital. Then I was on the waiting list for operation for 1 1/2 years. Such a relief to be out of pain. I believe the whole Public System needs an overhaul, re Specialist costs, waiting times especially for the elderly whose conditions deteriorate while waiting then outcomes are less successful, organising of Outpatients post op where, at my hospital, 40 to 50 patients were booked for the same hour resulting in waits of up to 3 hours with not enough seating and elderly post op Orthopaedic patients were left standing In pain, and then not being able to see the surgeon as told I needed to on 1st visit till 6th Outpatients visit. All very frustrating and time wasting. Don't get me wrong I do appreciate the good work the surgeon did and that it was available free, but in our society don't believe treating pensioners as second class citizens is necessary. It's the system that needs overhauling so that good care is available to all in a timely manner. Regards Judi. 

Robyn
Robyn from QLD commented:

I have come to the conclusion that is no such thing as real health insurance and certainly no such thing as comprehensive insurance. It cost you a lot for most of the time nothing. I pay top cover too while I can and when I can't afford to continue to pay for it I will just stop going to any doctors. When you are sick and out of action is when you can least afford to be receiving lots of bills. And don't get me going on "insurance" for dental and optical. I think it immoral what is paid out for these benefits when compared to the real costs. 

Kenneth
Kenneth from NSW commented:

Great story John, I have been an NIB member for years, still paying $389.01 a month, and I have no worries. Love the NIB, and no $200.00. Eftpos card, for me!!! Over n out Kenneth. 

Giovanni
Giovanni from VIC commented:

The most annoying thing about this, I had a. Torn bicep tendon which he to be mended, is that the same specialists that send private patients the huge bills, do the same operarions in the public system for the price of the Medicare rebate. I wouldn't be without private cover, but we are being fleeced by the doctors in this respect- they deserve to be well paid but...... 

Catherine
Catherine from WA commented:

I found Australian Unity good not to many out of pocket expenses . 

Laurence
Laurence from NSW commented:

Have similar shoulder. 3 years ago had full knee replacement. Loss of income $20.000 so no way could afford any more. Lots of direct enquiry enabled : operation, 10 days in -patient rehab and 2 weeks out-patient rehab.( pickup and deliver from home)......... Total cost..... $250 excess and $10 incidentals. 

Lynn
Lynn from QLD commented:

My husband also faced the myriad of extra out-of-pocket expenses John mentioned when he recently had an operation to correct arthritic damage to two toes. We have also been in top hospital for about 40 years with very rare claims despite having three children in the earlier years. We are both aged pensioners now, obviously with much reduced income, but have had to reduce our cover to intermediate hospital to help us to afford cover at all as we age. I'd really love to see a Politician or CEO of a Health Fund try to live, for one month, solely on a pensioner's income and see if they come out of the experience with the same 'user pays' philosophy. 

Tony
Tony from QLD commented:

Well 'bugger me'......I too have just had my rotator cuff done, and yes, I (had) top hospital cover prior to the last price hike. I'm well over $5000 in 'out of pocket' costs with still plenty of physio to go. Seriously, it would have been cheaper to play the pokies with a bung shoulder! Good luck with your recovery John....it's a long haul! 

Carol
Carol from QLD commented:

Did you check if Surgeon,Specialist and others involved were fully covered by your Health Fund I am concerned , as in the near future I will need a knee replacement and I could not afford the amount mentioned also were you advised before operation? 

Garry
Garry from NSW replied to Carol:

Good call Carol, I was fortunate to have my Surgeon and Anaesthetist covered by my Health fund for a foot operation. No gap fees, my first was at a private Hospital and had to fork out my excess $500 Basic Hospital. The second procedure was done by the same surgeon in a Public Hospital. Showing my privite cover all was covered zero dollars. Pays to do your homework 

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