It's like having car insurance, I don't get in my car thinking I'm going to have an accident. Same with private health.
I know way too many people who didn't have private health insurance and had to wait months and months for surgery. Some where in pain, others could have lost their jobs etc. to me it's not worth the risk. Public health is a mess.
It sucks that we need to pay for private health but unfortunately its a reality in Australia.
However even with private health you still have to pay Gaps and all these other costs. For us it's mainly peace of mind in that if something did go wrong (God forbid) we can get into surgery fast and not have a student cutting me open. ( yes yes I know they have to learn I would just prefer it wasn't on me)
That's just my point of view though.
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16-02-2016 20:04 #11
16-02-2016 21:49 #12Senior Member
- Join Date
- Aug 2014
We have top hospital (including pregnancy cover) and basic extras with nib. I was with nib for years then switched for a while then went back to them a couple of years ago.
The thing I like about nib (and a couple of others operate this way too) is I can go to any practitioner I choose and get a set % of the fee back. No guessing how much I'll get, no need to go to 'their' dentist etc. I think we get 60 or 65% back of whatever the charge is. I like knowing what I'll get every time and I find their limits generous.
With extras we just get the more basic level that covers dental (including major dental though as we both have problematic teeth), physio, optical as the main things. I don't pay extra for having 20 extra things that I won't use like acupuncture, Bowen therapy, chiro and whatnot. So for us basic extras works well and we get back more than what we spend in premiums that way.
We have top hospital as had a baby last year. We probably won't have another one but will maintain this cover for 1-2 years just in case. I'd hate to be caught out.
For us we'd also have to pay Medicare surcharge if we didn't have hospital cover but I'd have it anyway. DH is almost 41 and I'm 34. If we drop hospital cover then want to pick it up later we'd have to pay lifetime health cover loading penalty.
DH plays sport and has bad knees he had knee surgery last year. The surgeon he saw privately booked it for the week after his first appointment. My colleague waited 4 months just to get an appointment in the public system last year for a similar problem and was in a knee brace, in pain potentially doing more damage in that 4 months. I had back surgery 5 years ago that I would have waited 1.5-2 years for in public. Again I had it within a few weeks.
Hospital cover is great for when you need surgery for something like that which is non-life threatening (so may take a while in public hospital or maybe not if you're lucky) but potentially major life impacting if delayed. It's worth it for us and we can afford it but many many people are happy without it and see it as unnecessary.
As for gap fees we have a $500 excess, with DH knee surgery we paid that + $165 gap for anaesthetist. For my back surgery the surgeon charged a $300 gap fee not covered by insurance. With my baby aside from the ob management fee I had about $200 worth of ICU gap fees and a gap fee from the paed for about $250 (DD was in hospital for 2 weeks).
As I said for us it's worth it knowing that if we need it we can choose our own specialist and get treated quickly at the hospital of our choice and yes perhaps nicer comforts too.
Public hospital system is great for serious life threatening and emergency cases.
16-02-2016 22:10 #13
Thanks for all the advice, very helpful. I completely understand its insurance that you hope you never have to use but if u need it its there. I discussed with dh that we insure our car but not ourselves, pretty silly really.
As we can only afford basic hospital cover i was worried it wouldnt be worth it. We too would have a $500 excess but worried we would be slugged with lots of hidden costs if we ever needed to use it. I just want to make sure that if we did need it, it will be worthwhile - even with basic cover.
NIB had the best deal after doing alot of research. Has anyone had much experience with them? (Thanks Gingermillie for your feedback on NIB!) Basic hospital plus extras $600 each for both general and major dental ( they werent combined as i found with some other policies) optical $250, physio $300 60% back until benefit used up.
Was quoted $71 a fortnight but im worried its not going to be good enough.
Here is what is covered, can anyone suggest if theres exclusions i should be concerned and from ur experience if this is a satisfactory cover.
Also do u have to pay full fees then they reimburse you or do you just pay the gaps upfront?
Our dd may need grommets again in the future ( i know there would be a 12 month waiting period) but would our only out of pocket cost be the $500 excess? Sorry for all the Qs
Last edited by SoThisIsLove; 16-02-2016 at 22:13.
16-02-2016 22:38 #14
When we were shopping around I looked at NIB basic hospital (the one you have pictured) as we only have it for tax purposes.
We decided against their policy due to the 'covered' procedure list there. We thought there was too much scope for them to decline to cover a certain procedure.
We ended up with AHM basic hospital and super extras (we want great dental cover for orthodontics and major dental).
You can separate your cover and have extras with one insurer and hospital with another (just a thought). We will be doing this this year as we are unhappy with Medibank (owners of AHM) and their contracts with the hospital.
I will probably end up with hospital with BUPA and keep extras with AHM as their claiming process is really easy.
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16-02-2016 22:47 #15
Im not sure i understand what u mean, i looked at several health care providers and all their policies for basic hospital looked pretty much the same?
16-02-2016 23:47 #16
We have basic hospital and dental with AHM but we pay more than you do a month. With our extras most of the time our dentist or physio has HICAPS so we just pay the gap at our provider. Even if I pay full fee its a super quick claim process and the refund is back in my back in a couple of days. AHM is a little different as there's an annual limit per person and you can seem to spend it how you like (within reason)
With your daughter's grommets if you have a specialost appointment outside of the hospital your insurance most likely wouldnt cover that. So you would pay say $100 for the ENT appointment then some back from medicare.
17-02-2016 06:49 #17Senior Member
- Join Date
- Feb 2012
- Sydney NSW
Hi there, yes you will still get slugged with heaps of extra costs if you need to have anything done in hospital, i had a day procedure which needed to be done asap due to discomfort. Because i had private, i didnt have to wait 12 months, i had it done literally the next day. It still cost me $1000 but the alternative of waiting was intolerable. Private means you can get quick access but it means you will pay!
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17-02-2016 07:24 #18Senior Member
- Join Date
- Aug 2014
Re out of pocket costs for hospital that depends on the specialist and anaesthetist as to whether they accept the private health insurance payments as total payment. Some charge a fee in excess of that so no matter what phi pays they charge you an extra fee but varies by Doctor. Some health insurance companies don't charge excess for day procedures or kids admissions - not sure about nib though.
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