The cost of getting sick...

My LOML has just had a breast cancer diagnosis confirmed today...and that of course is rather un-nerving to our family. Medical service has been excellent and tomorrow, the surgery will occur. Thanks to our daughter, who is a breast-screen radiographer, the problem was picked up early and LOML packed off quick smart to get it attended to. Consequently, the expected outcome is good. (no sign of it getting into lymph nodes etc)

Now comes the real shock where my LOML is concerned... we pay top private cover... $360 per month, but the expected gap is over $3000 just for the surgeon, then there is the anaesthetist and whatever else. (I think this worry is causing my wife more concern that her medical condition) Now I am quite happy to do whatever and pay whatever to ensure any one of my family's health and I have wonderful children who are only too happy to help and we have all reassured her that she is more important than any amount of money and we will manage just as everyone else has to.

But what is going on! The Govt basically forces us to take out private insurance and then sets a scheduled fee that is so far below what Surgeons are charging. By law, you can't insure for these sorts of gaps. To me it is just a rip off.... the govt forcing/coercing you to pay for something that they make sure you get no help from!!!!!!

The main thing is my dear wife gets well as soon as possible!

Chipman

Chipman,
Not the best of news.Sorry.
Are you sure the surgeon is so expensive.Sounds like LOYL will only require a "lumpectomy", with no lymph node excision etc., so it should be a fairly short and relatively simple proceedure which shouldn't leave you with such an enormous "gap"
LOML had benign colon cancer scare, a week in hospital(private) ,a bloody great incision from diaphragm to pubis, and the whole lot set us back about $500.(She's 100% now.)

I am not a medico, but AM a Vet, and I have done hundreds of very radical surgeries on lady dogs with similar problems, so I have a vague idea what is involved.

Check with both your surgeon and your fund before you sign the consent.
Good luck'
Jim

I understand what you mean and yes, I did check with the surgeon and the fund this afternoon and that is what it is. No problem with hospital and theatre fees, these are all covered. Once you get started on the journey, it is very hard to change and there is no way I wan any delays for my wife. I would not have been suprised by a few hundred dollars but this was a shock. I have had surgery myself (gall bladder) and out of pocket expenses was less than $200 as a private patient. I know insurances are high for surgeons but....

Thanks

Chipman

My wife is a survivor of the dreaded bc, mastectomy of left breast about 4 years ago.She has had great support from womens groups and be assured she is not alone in her fight,she only has to ask for support ,she was diagnosed when we were living in Kiama on the south coast and had marvellous help and care all along the way.Hope all goes well and she doesn't lose too many lymph glands.
Know what you are talking about with gaps in surgeons fees she has just had total knee replacement which left us about $3k out of pocket.Sucks doesnt it!!:2tsup:

Good that they seem to be getting in ealy. Hope everything goes well and the money does not get too much in the way. "The gap" has always been a strange thing to me. :shrug: They have their reasons I guess. :dunce::rolleyes:

Thanks TL,
Health is more important than money. Between myself and my kids, we have the money side covered.


It is the system that is the problem that gets you to pay such large premiums and you still get huge gaps that you are not allowed to insure against. I can understand why many are deciding to opt out of private cover.

regards,
Chipman

I'm gobsmacked...that much for premiums......and there's a "gap"

Bugger!
I hope all goes welll though.

Does the Medicare Safety Net help at all?

http://www.medicareaustralia.gov.au/...y-net-work.pdf

Chipman....apparently Australia's health plans are similar to the U.S.'s when it comes to "out of pocket" payments. About the only way around the situation is to have 2 or more medical policies, but who can afford that.

Will keep your wife in my prayers.

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Originally Posted by watson

I'm gobsmacked...that much for premiums......and there's a "gap"
.

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Exactly!!!!!


Thanks

Chipman

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Originally Posted by Ron Dunn

Does the Medicare Safety Net help at all?

http://www.medicareaustralia.gov.au/...y-net-work.pdf

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Thanks for the reminder Ron and I have just registered online but sadly it does not cover surgery or in hospital expenses.

Chipman

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Originally Posted by Ed Reiss

Chipman....apparently Australia's health plans are similar to the U.S.'s when it comes to "out of pocket" payments. About the only way around the situation is to have 2 or more medical policies, but who can afford that.

Will keep your wife in my prayers.

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Here we are not allowed to have multiple plans to cover the gaps. That is what I find annoying. The govt sets an unrealistic schedule fee but the medicos charge way more and you can only claim up to 80% by law of that scheduled fee and for in hospital treatment the health fund can legally only cover the 20% gap up to the scheduled fee and then you are on your own no matter how much your premium is.

So what it means is that if you get sick, you are expected to go shopping around trying to find a specialist or surgeon who is prepared to do it for the cheapest price as a private patient (but is this always possible?)

Alternatively you can turn up to a public hospital and pretend you have no cover and go on a long waiting list to be treated and it will cost practically nothing. My wife's brother had a brain tumor and was treated very quickly and well as a public patient. (he had opted out of private insurance)

So here is the stupidity of it all. The Govt penalises you if you don't have private insurance through the tax system and then you end up paying way more out of pocket on top of it! but yes you do get "choice" of doctor and are likely to be treated earlier.

Any way Ed really appreciate your kind thoughts and prayers (atleast the govt hasn't got a charge on that)

Thanks,

Graham

...hey Graham, hope the lil woman is coming along nicely.
As far as this crapola gap payment is concerned, nothing you can do about it this time mate:no:, but next time, should you need the services of doctors surgeons etc, ring your health fund and ask for a list of doctors surgeons who charge within the scheduled fee range.
This way you can make your own choice as to who and how much.
We all learn the hard way unfortunately.

Glenn

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Originally Posted by wolften

...hey Graham, hope the lil woman is coming along nicely.
As far as this crapola gap payment is concerned, nothing you can do about it this time mate:no:, but next time, should you need the services of doctors surgeons etc, ring your health fund and ask for a list of doctors surgeons who charge within the scheduled fee range.
This way you can make your own choice as to who and how much.
We all learn the hard way unfortunately.

Glenn

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That is true....wrongly thought that because I had top private cover it would be "reasonable"....perhaps a reminder to us all to ask questions first...

A bit hard to change surgeons once you get so far along the track. You get reccommended to a particular person and once you go through the initial consultations and it gets down to you need surgery and you are vulnerable due to the stress of it, it is so hard to become mercenary about money... "So wife, luv ya lots and lots but that is too much money"... implies "you are not worth it"

Perhaps surgeons should provide a statement on how they relate to the schedule fee at first contact.? OR the govt and surgeons get a better arrangement with realistic scheduled fees and control of overcharging. In other areas there are rules about costs and over charging etc.

The main thing is my wife gets the best treatment. (only the "system" that gets people annoyed)

cheers,

Chipman

Chipman,

Hope everything goes well. Unfortunately we are at their mercy and there seems to be no control over what they can charge. Wait till you see the anaesthetists' bill.

I had a carpel tunnel op, the surgeons' bill was ok but the girl at the private health care fund said the anaesthetist charged 4 times the scheduled fee. That was a bit of bummer as I had to fund that (probably part of his overseas holiday).

Next time I had an op was when I mangled my finger. Told the surgeon I was privately covered but told the anaesthetist I was not. Never saw a bill from that one.

Morning Chipman,

Hope everything goes well for your wife.

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Originally Posted by Chipman

A bit hard to change surgeons once you get so far along the track.

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Different situation in a small city.

We had a similar experience in 2005 when my wife was diagnosed with cancer. At the time we weren't in a fund and so the surgery was performed in a Public Hospital but as we both work in hospitals we "know" the surgeons, the choice is easy, which is an enormous benefit for that "peace of mind" component. To us, where (Private vs Public Hospital) the surgery is performed is less important than who does it, especially considering he had admitting rights to both hospitals.

Would your surgeon have performed the surgery in a Public Hospital?

Eventually we joined a fund, as our youngest son now has an Insulin pump, but personally I don't think we're better off.
Last year my wife became seriously ill while holidaying and despite the fund, the only Private Hospital in the area did not have an A&E Department and the much vaunted phrase, "choice of surgeon" was useless because...

A) We didn't know any of the surgeons, and...
B) There was only one surgeon available/on call.

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Originally Posted by Chipman

...perhaps a reminder to us all to ask questions first...

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Very hard at the time, but yes.

Best wishes,
Graeme

My LOML just got back from hospital and everything health wise is looking good...just the recovery now.

Thanks to all those who expressed their concern, it was greatly appreciated.


Graham

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Originally Posted by Chipman

My LOML just got back from hospital and everything health wise is looking good...just the recovery now.

Thanks to all those who expressed their concern, it was greatly appreciated.


Graham

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Just the recovery? Good to hear. Hope all goes well. (It all happens pretty quick doesn't it.:C )

Onya, mate.
Give her an enormous hug from us all.:2tsup::2tsup::2tsup:

Sounding good medical wise.

All the best.

Bob