Pls pls pls answer these questions for me???

[Janesmum123]

We need to get PH asap we have been putting it off for to long.

Pls can you answer these questions for me..

1) If I have PH can I go to a Private hospital for emergencies? How much does this cost on average? and do I get any money back (meaning instead of going to like westmead public and waiting 10 hours to see a doctor)

2) What is this "pregnancy management fee" everyone is talking about where you pay like 3.5k for an OB and get nothing back? (I think this fee is paid around 20 weeks or something)

3) Do I HAVE to go to a dentist that is covered by my PH or can I go to any dentist? Will I get less back if I go to any dentist?

Thanks heaps in advance...

[myhusbandswife]

Ill answer best i can. I am with HCF

1. Im not sure about other areas my locsl private hospital doesnt have an ED so we have to wait just like everyone else at the public. However the public and private are joined so if admitted its easy to get transferred over.

2. Depends on the OB how much they charge for their management fee. My OB charges $300 management fee. I was out of pocket about $900 for my whole pregnancy and birth including hospital excess, anethesist, OB, ultrasounds and paed

3. Unsure ive been going to the same dentist my whole life

HTH

[moozle]

A lot depends on which health fund you choose. Almost all of them have an excess that you pay for the first few days of any hospital admission and then they cover the full cost after that time. From memory mine is $200 per day for 2 days but they are all very different and we have maximum cover and paying a lot!!! As in about $400 a month!

As for choosing your own dentist etc, again all differ. Usually they will give you a certain percentage back (rarely all for anything) but you are responsible for the upfront costs and they reimburse you afterwards. Unless the dentist is registered with your fund to have no gap payment, you have to pay.

I think op answered about the obstetrician but remember if you end up in surgery, there are added costs of anesthetists, and theatre costs etc which you get some money back for but not even close to all. We ended up about $5000 out of pocket but maybe got half back from Medicare and health fund combined. Was worth it though as we ended up with an emergency ceasar.

[Mrs Nietzsche]

Private health is sort of like medicare - they contribute to costs, but genreally don't cover everything. YOu know how some GPs bulk bill - only charge hte medicare amount? Well some doctors only charge what your PH fund covers, but they are RARE. I have top hospital cover and gold extras, and DH is having knee surgery soon and we will still be out hundreds - and that was with finding a surgeon that agrees to only charge close to what the fund will contribute. Our first choice of surgeon would have left us out of pocket thousands.

Private hospitals dont have emergency. YOu will mostly use your private health cover for surgery, or for extras ie physio, dental. You have to shop around to find a dentist, or physio, or whatever, that only charges the fund's contribution. For example, DH and I recently went to the dentist and still paid $120 despite just having a bit of a checkup and clean NOT HAPPY. I get acupuncture and am still $38 out of pocket (fund pays about the same). I am getting orthotics this week, fund is paying about $250 and I am paying about $100.

You can go to any dentist, or any specialist etc that you like, but only a very small few of them will have an agreement with your fund to only charge waht the fund will pay. It's hard to even find those ones.

[Janesmum123]

So basically the only point to PHI is that you don't have to wait for an operation?

I'm trying to understand it all but it just seems pointless to me.

In Tassie you get everything free, when I gave birth I got a private room free, gyno free, nurses came to my house for 2 weeks free, specialist cost me $60 of of pocket but we are going back to Syd and I know how bad the public hospitals are there.

It's so fustrating because the quotes I'm getting is like $250-$300 a month and I feel like it's for nothing.

[Hannahsmumma]

My private hospital has an emergency department.

I am with MBF and if I went to hospital with an emergency I would have to pay my $250 excess. But that excess is only paid once per year, so if I or another family member end up hospital more than once we don't pay the excess again.

You can go to any dentist etc and just send the receipt into your health fund to get the rebate if the dentist doesn't have machine thingy to take the discount/rebate off the bill immediately.

My Ob has a $1,700 management fee of which medicare refunded $420 approx. Really unsure what this covers and why I pay it. I've never asked.

I also pay $210 per month for the 4 of us. Soon to be 5.

[Mrs Nietzsche]

Yeah it is pretty tricky.

So no waiting lists. You *do* get part of your extras (physio, dental, glasses, etc) covered which is useful (how much depends on your cover). And you can choose your own doctor (which you can't in public).

Also for many people the tax break means they come out even or even-ish.

PH doesn't contribute to your specialist appts either, so you still pay for them then get your medicare rebate.

[sweetseven]

I have extras cover (with MBF).

If I go to a Membercare dentist for general dental, then I'll get charged 20% for dental, but MBF specifies the fee that the dentist has to charge.

If I go to any dentist, then I'll pay upfront then get a prescribed amount back (which seems to be about half what MBF will pay a Membercare dentist on my behalf).

Major dental I had to pay about 50% to a Membercare provider, and dont know if there would've been a difference in the OOP if I had gone to any dentist. (I went for a filling, but ended up with preparation for a root canal.)

[ALHmum]

I work in a private hospital and it has an ED. If our patients go there they can only get money back from medicare and not their healthfund. And they have to pay before they get seen. May be different at other hospitals because our ED is operated by a different group than the hospital.

If there's a private hospital with an ED that you are thinking of just ask them what they do.

And if they get admitted to the hospital then they need to pay their excess/copayment etc. That is on top of what they pay at the ED.

My Management fee was $1750 and i got most of that back thru medicare cos i had reached my threshhold. But healthfunds usually don't give you anything.

Can't help with the dentist question. We go to one that uses hicaps.

[Janesmum123]

Ok thanks looks like we are turning into America.

Basically you get good health care if you have money and if you don't then to bad.

[Izy]

We need to get PH asap we have been putting it off for to long.

Pls can you answer these questions for me..

1) If I have PH can I go to a Private hospital for emergencies? How much does this cost on average? and do I get any money back (meaning instead of going to like westmead public and waiting 10 hours to see a doctor)
Anyone can access private emergency. The consult is billed through medicare, but the hospy can also choose to charge aditional fees that are non-claimable from either PHI or Medicare. Your PHI only becomes involved if you need to be admitted. You don't want to risk admission in a private facility if you don't have insurance... those bills can be scary!


2) What is this "pregnancy management fee" everyone is talking about where you pay like 3.5k for an OB and get nothing back? (I think this fee is paid around 20 weeks or something)

The PMF is an extra charge cause some OB's don't think they're getting enough. It varies between obstetricians but since it is an outpatient service you are not able to get a benefit back through any registered Australian health funds. PHI is only there for INPATIENT and for Ancillary (extras like dental etc)

3) Do I HAVE to go to a dentist that is covered by my PH or can I go to any dentist? Will I get less back if I go to any dentist?

You can go anywhere, but depending on your fund you may get more with agreed providers. Often these providers promise to charge a more reasonable or at least consistent amount and the funds agree to pay more to say thanks for looking after their members.

Thanks heaps in advance...

The idea of the PHI is to give you choice. Ideally if someone is in dire need of treatment they should get it through the public system. The PHI is just an extra choice. It's a bit of a catch 22. Does using the PHI industry further segregate private from public, or does using the PHI industry help reduce the pressure on the public system


My private hospital has an emergency department.

I am with MBF and if I went to hospital with an emergency I would have to pay my $250 excess. But that excess is only paid once per year, so if I or another family member end up hospital more than once we don't pay the excess again.
Just double check that with the excess. Normally it's payable twice per family.