What can we do to get value from our private health insurance?
There’s been some sobering figures out this week about how 40% of those of us aged more than 45 suffer from at least two of the eight most common chronic diseases.
The two most frequent maladies, arthritis and cardiovascular disease, usually occur alongside each other and back pain according to the Australian Institute of Health and Welfare (AIHW).
But there’s still one chronic pain which afflicts far too many patients who use the health system and for which there appears to be no ready cure apart from vigilance.
Its symptoms are shock and surprise, followed by disbelief and doubt and then a rapid onset of anger and frustration with a system that’s meant to make us better.
It’s the dreaded gap payment or those bills from private hospitals, or doctors and other health professionals which aren’t covered by Medicare or private health insurance.
Simply put it’s the amount you have to cough up for medical or hospital charges which exceed the sums Medicare or private health insurance are prepared to pay.
The average out-of-pocket expenses (a ridiculous expression as who has this much cash in their trousers?) for a private hospital visit is $285 and for extras cover, ie the dentist, it’s $46, according to a recent study
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A CHOICE survey of its members found almost half paid extra for a private hospital visit usually less than a $1000 but for some up to $5000.
What’s worse a quarter of the 740 respondents said they hadn’t been warned of the extra costs beforehand and where information was given it certainly wasn’t clear.
A university lecturer recently wrote about the FOG, or the fear of the gap. He was very happy with his treatment but when he couldn’t get a straight answer as to what the extra costs would be opted for a no cost public hospital after a minor accident.
And he’s not alone. It’s estimated the well-realised fear of the gap sees many use the public system, which the whole private health insurance scheme to meant to relieve, instead of facing unknown and gaps.
So what can we do to get value from our private health insurance, where we choose or can afford to have it, bearing in mind we’ve probably also paid for Medicare through various levies ie taxes?
The onus is firmly on the consumer, that’s you and me , to check with the doctor and others involved in the procedure, such as anaesthetists, as to what their charges are. They should provide an estimate if not use someone who does.
You also need to check with your health fund to see what’s covered in the policy and if there are any excesses or exclusions.
Again too many of us, according to the research, are NOT adequately appraised of what policy we are paying for and end up facing additional costs and even no cover at all for certain conditions.
Most funds have medical gap arrangements with doctors and hospitals which can reduce or eliminate the out-of-pocket expenses. If you use another provider who isn’t bound by such agreements it can prove costly.
In short it’s up to us to ask the right questions of all the parties concerned from the fund to the doctor and then hospital and even then it might not be either understandable or reliable.
Doctors can charge as they see fit. Hospitals have all kinds of fees and insurance policies as ever have their own tricks and traps for the unwary.
You might ask why bother paying in the first place?
One reason is the largest users of private health insurance hospital benefits are the cohort aged between 60-79 years old.
Given the prevalence of those chronic diseases they probably want some choice and control of their treatment which they believe the private system offers especially in terms of avoiding long waiting periods in the public hospital system.
Even before the gap payments such insurance comes at a real cost so beware and never be scared to ask those questions.
Check out the federal government website privatehealth.gov.au which reports on the percentage of hospital procedures each health fund covers with no gap.
Tell us your experience with out-of-pocket expenses by provided your comments below.
