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News12 Million Reasons To Act Now On Private Health Insurance
12 Million Reasons To Act Now On Private Health Insurance

12 Million Reasons To Act Now On Private Health Insurance

A few days ago some private health insurance funds said they’d help consumers get more value for money out of their policies by giving  more information about out-of-pocket and other annoying extras.

Sharing our experiences of gap payments can be handy in choosing a specialist but there are steps we can take now to save ourselves, if not the healthcare system.

About 12 million Australians have some form of private health insurance, half are on incomes of less than $50,000 per year, and they play a crucial role in reducing pressure on public hospitals in terms of waiting lists and budgets.

But we have the unsustainable position of those who pay insurance facing higher costs each way above inflation.

So what’s to be done? The federal government says it’ll bring in more easily understood categories for health insurance, such as gold, silver or bronze to indicate was kind of coverage they really provide.

The reforms include simplified billing and standard definitions for medical procedures to allow easier comparisons.

But they only go so far. Here are some ideas to help in choosing and using health funds without shifting more costs or confusion onto consumers:

  • Simpler information about out-of-pocket costs, available at the right time ie before the procedure:

Out of pocket costs are surcharges by any other name and are imposed on health services by specialists. Medicare will cover a certain level of your costs, your private health insurers some more, but in the end, some specialists can charge pretty as much as they like.

Requiring that all expected out-of-pocket costs are disclosed before a medical procedure would reduce so-called “bill shock”. It’s said transparency is the best disinfectant in which case we need a hospital grade variety to improve this area.

Choosing a policy: Rather than reducing our options government and industry should be making the choice easier for consumers. This doesn’t mean stifling competition by scrapping the lowest cost so-called  “junk policies”. For those, especially younger people, who want a cheap-as-chips policy to  keep the government levies and surcharges at bay and have little intention of actually using the cover, they are a valid and legal option. Yet both sides of politics have demonised these very basic policies and want to make customers pay more for cover they don’t chose to take out!

  • Stop pressuring patients with private health insurance in public emergency departments to pay twice:

It’s solely up to the individual consumer to chose whether or not they elect to use their health fund cover in a public emergency department. The encouragement by hospital staff to go private instead of public, and then face higher costs instead of no cost for often little difference in treatment, may not be in the consumers best interests and is effectively double charging.

The consumers’ needs as opposed to the industrial and professional interests of hospitals, funds and specialists etc, must be paramount. Restricting choice, shifting costs onto already burdened personal budgets and being less than 100% open as to all the costs is testing all of our patience.

 

Originally posted on .

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Someone
Someone from NSW commented:

I think there definitely should be a comparison of out of pocket costs between the various health funds. We seem to be at the mercy of these funds who are quick to increase their fees each year and slow to provide information regarding benefits and out of pocket costs. My husband and I are in the category of having stayed with the same health fund for years because we are unsure of the benefits of changing funds.. Helen 

Someone
Someone from VIC commented:

I would like it to be EASY to compare health funds. We (married couple plus two children, one of whom now has her own cover) have been with BUPA for many years, but have been wondering whether to switch to Defence Health. But are they any better? It's so hard to compare "apples with oranges". When you listen to the advertisements they all seem to be great! 

Someone
Someone from QLD commented:

Would love to join this club. I was recently admitted with pains around my chest into Pindara PRIVATE Hospital with a terrible outcome. Despite having full Hospital Cover I was out of pocket almost $2,000 dollars! Now attempting to resolve the problem with the department of Qld Medical Health Ombudsman. I would love a review of this practice. 

Ruth
Ruth from NSW commented:

I have recently had an operation in a private hospital. The anaethestic's bill stated the item numbers without individual costs. After submitting the bill to both medicare and my private health fund all items were processed with medicare stating the scheduled fee and no gap payment payable by the patient. However, the charge of the invoice was for $800 more than the fees being submitted to medicare with no itemisation of the gap payable by the patient. Is this legal and should the remainder of costs be paid to the anaethestist? The charge is approximately 5 times the scheduled fees? Talk about bill shock. RL NSW 

Joseph
Joseph from NSW commented:

On the occasions that I or members of my family have been admitted to Westmead Public Hospital emergency department and subsequently transferred to ICU/general ward under my private health insurance it has always been with no gap payment. Has this changed? 

Someone
Someone from NSW commented:

Married couples, with no children or when their children are no longer covered by their family membership should be given a discount on their premiums. Also the extras cover limit for miscellaneous services such as oesteopathy, remedial massage, etc should be a joint limit instead of individual limits. My husband does not use his extras cover at all and I always exceed my limit, so I receive no rebate towards the end of each year even though we pay high premiums for our health insurance with HCF, which we have held membership for 45 years. It is time the health funds gave their members better benefits and premiums. Regards, Sue Whiteside from NSW 

Paul
Paul from NSW commented:

I was a member of a health fund for close to 30 years transferred over to HCF as loyalty to the old fund was not beneficial. New fund worked great , no hassles but one problem I was told all my benefits from the old fund would be the same with HCF , broke a tooth while overseas and find out that I have to wait out a 12 month period before I can claim on my new fund. Can't afford out of pocket $3000 so I'll grin and bear it for another 7 months. 

Peter
Peter from WA commented:

Theres too many health funds. Theres over 40 companies employing thousands of beaurocrats who push pens and operate computers. That money should put to use helping people get better and not hindering as the funds always do. 

Helen
Helen from NSW commented:

Raj completely agree with you, previously with Australian Unity & they issued a booklet with all the item no's, most impressed, currently with Navy Health & they are not as open. 

Helen
Helen from NSW commented:

Raj completely agree with you, previously with Australian Unity & they issued a booklet with all the item no's, most impressed, currently with Navy Health & they are not as open. 

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