What does a laparoscopy fall under and waiting period?

[Bibs]

Hi all

Just have been told by my Gyno that I need a laparoscopy which may help me get pregnant. Now we don't have PHI and I was wondering what this procedure falls underneath in PHI and what kind of cover would I need? Also what about waiting period.

If anyone can help thanks

[Nettle]

Hi Bibs,

You'll need hospital cover for that one even though it is day surgery. Most places have a 12 months waiting period on hospital cover so may be worth getting your name on the public list in the meantime. May not be any faster though as it will be for investigation purpose which makes your case low priority in a choked public system...

I ended up going private and paying the whole hog cause I was still in the waiting period.

[LibranTwin]

I'm not really sure, but if is pre-existing will PHI cover you?

Do you actually need PHI? Will the public system do it? I got my appendix removed through the public system, it wasn't urgent and I waited 2-3 months for the surgery.

If you need PHI call someone like iSelect they will know what level of hospital cover you will need and who will give you the best price.

HTH

[Bibs]

Thanks for the replies:)

The gyno suggested the lap surgery because we've been ttc for over 12 months now and i ovulate with regular periods and DH's sperm count is fine. So he thinks there may be some blockage or endometriosis. So I don't know if it's preexisting because it's all let's see if there is a problem and if there is we'll treat it procedure, iykwim. I've rang my Gyno and his receptionist said he will look at my case and let me know about the waiting list for public hospital. I couldn't believe the costs of the actual hospital fees, it was more than the actual surgery and none of it is covered by medicare, :eek:

[Nettle]

Hi Bibs,

I'd have my money on them calling it pre-existing given that you've been symptomatic (unable to conceive) for 12 months prior.

I know with mine, I had heavy and very very painful periods. They found endo on the lap but I wasn't covered during the waiting period.

In terms of Medicare rebates. You will receive a couple hundred back for the cost of the anaesthetist but that is all.

I had the dye studies done while I was under but you can always ask about having a HSG or hycosy to check of your tubes are clear. You'll be in for a wait either way so this will get something done in the meantime. Also, there is suppose to be an increased chance of conceptions in the three months after the procedure is done.

[Bibs]

Thanks yeah I got a breakdown of all the costs incl surgeon fees, his assistant, the anaesthetist with the medicare rebates for each also. It's the hospital fees which has astounded me, the hospital fee by itself has quoted $4680. I was seriously expecting it to be $1000 or something. Pretty naive of me but then again I've never been in a hospital before other than when I had my emergency c section at a public hospital.

The Gyno said he'll do everything whilst i'm under incl the dye test.

[Nettle]

Hi Bibs,

You are being taken for a ride!!! :eek:

I paid just over $2500 for the whole lot:

Day surgery (no overnight admission)
Laparoscopy
Hysteroscopy
Dye studies
Diathermy removal of endometriosis
Anaesthesia

Are they intending to admit you overnight?? Why is it costing so much?

[Bibs]

I'm in Sydney and the hospital is Westmead private. It's just day surgery so no overnight

Wow you got all that for $2500

The actual procedure incl hospital fees has been quoted about $9000. The surgeon is supposed to be excellent he's won Australian of the year etc but he's charging $1900 just for himself.

[Izy]

Yep, maybe get another quote. Would the surgeon operate under a public hospital if you don't want to comprimise on the 'who'?

AS for private... well yes, Since you've already been told to go have it done you'd be calling it a pre-existing condition. As a diagns=ostic procedure there is a TINY chance of a 2month wait, but i wouldn't expect it

[overitand36]

i would be going with no chance on a 2 month wait

in the eyes of the health insurance companies everything is preexisting

also agree that $2500 is rather cheap did not get quote for my latest procedure as now have PHI

[Izy]

i would be going with no chance on a 2 month wait

in the eyes of the health insurance companies everything is preexisting

Thats a bit pessimistic. The healthfunds in Australia are a bit different to the stereotype you hear about. It's all about signs and symptoms here. If there were no signs and symptoms it's not pre-existing.

I work for a large fund and we even cover some diagnostic procedures like colonoscopies after 2months even when the patient has had previous cancer etc.

[Bibs]

Well I called around some other private hospitals and got a few different quotes and still waiting for people to get back to me. I have found a private day surgery place which hospital fees are less than half of westmead's quote and the surgeon is also cheaper by $600 and I've heard good reviews of him. He won't be free till February though plus the 1 month waiting to get a consultation with him as the first step.

As for my current surgeon he won't do it if I do it in a public hospital, his fellow associates will, but I'm not that worried about that. I'm still waiting from his office to hear what the wait list if like as a public patient though. Hopefully I'll have some answers on Monday.

Thanks for the replies everyone :)

[nat278]

My DH had his vasectomy reversed in July this year, we only took out PHI in March this year and submitted forms (pre existing condition forms) to our health insurer (Peoplecare) in May that our GP and surgeon had filled out and the fund made their decision based on what Drs wrote.

We assumed having had a vasectomy would automatically class a vasectomy reversal pre existing, but GP and surgeon wrote on the forms that we only decided to get VR done after March so the need for the op only happened AFTER joining Peoplecare, they approved and covered the hospital, part of surgeons and anaethitist fees. Saved us about $3000 overall.

I think the fund also took into account that for covering what to them would be a small day surgery amount, they have won our membership forever and I can never speak highly enough of their customer service.

So long story short some PHI aren't black and white when it comes to these things and will look at the big picture.

[Izy]

wow! I've never heard of a fund paying for vasectomy reversal at all! Thats awesome!

[Bibs]

Well the gyno i went to won't put me in the public waiting list so it looks like i have to fork out some money. So i'll have to go back to the GP and get another referral.

Thanks nat278 may i ask what kind of cover you got? What is the waiting period for a laprosocopy under PHI, would you know? If i got PHI first and then went to another Gyno for a consultation first and then he suggested a lapro then it wouldn't be a prexisting condition, would it? Sorry so many questions. If any one else can answer these questions that would be fantastic.

[Bibs]

Hmm well I looked at peoplecare and the waiting period for anything other than rehabillitaion, psychiatric, pallative, optical and health managment programs is 12 months :(

is that normal for all covers for hospital stays?

[nat278]

Hmm well I looked at peoplecare and the waiting period for anything other than rehabillitaion, psychiatric, pallative, optical and health managment programs is 12 months :(

is that normal for all covers for hospital stays?

Yeah I think all PHI funds have same waiting periods for those sort of things government regulations it not the funds themselves ( think it's to stop people taking out cover getting operation etc then cancelling policy afterwards) TBH I think getting a second opinion on lap may be worthwhile regardless of PHI they may have alternative to needing it or use different hospital etc and will be cheaper, or like you said take out cover see someone else in a few months and then apply to fund to see if they class it as pre existing.

I can recommend Peoplecare for their customer service and cover, only do top level hospital and for us as a family with mid level extras (what they call silver plan) we pay 50.50pw (including a life time health loading for DH as he was 36 when we took out policy), which I think is reasonable and they pay claims quickly, we sent claims via Medicare (2way claim form or something) and had cheque in mail literally 7 days later.

When deciding to get PHI look at how much fund will pay and how much you pay to be in fund for a year, for us it's $2616 for a year roughly Peoplecare paid $3000ish toward DHs VR so more then what it cost in premiums and we got best of both worlds Private cover and the VR, and by time I'm pregnant and birth will have served waiting period so have options for birth privately if I want too.

[mumstheword4]

Hi i just thought i would tell you my story.
I got PHI in april. I started seeing a gyno in may due to having irregular periods since having a MC in february. my periods were 25 days then 54 days then 35 days ect so i just wanted to get them back to some form of normalicy. anyway in september after deciding to have another baby the doctor wanted to do a lap and dye. I couldn't get covered under my PHI due to it being a pre existing condition. They classed it like that due to having irregular period since before taking out health cover. So from personal experience i can tell you that you will be considered to have a pre-existing condition as the symptoms can be dated back to before cover was effective, somethimes they even class is as pre existing if it happens within the first 3 months of cover.

hope this helps

[Izy]

mumstheword, i had the same situation but before kids and mine was covered. It was because the 'symptoms' can also just be classed as normal for some women, but for others it indicates an issue.
If you were already exploring the possibility of a lap before getting phi than it's preexisting.
If you were to buy the insurance, then see a specialist and they decide to undertake a diagnostic procedure to see if 'normal' is not normal than it might be a 2 month.

I'd never encourage someone to be dishonest, but bringing the info from your first ob to the table will almost certainly result in 12mth wait