Cataract Surgery - Not Covered in The Health Fund Plan

LEvaEva on 13/02/2018 - 15:13
Last edited 13/02/2018 - 15:29

Hi all,

I am 44 years of age and noticed that in past 6 months my vision got progressively blurry. Went to the hospital, they said I had dry eyes and sent me away. Saw an Ophthalmologist only to discover that I am suffering from Posterior Subcapsular Cataract, which is the cataract that happens in younger age if you are unlucky and fairly aggressive and progresses pretty fast. I am struggling already in my day job. I have a health fund with Bupa charging me roughly $400 a month but its useless in this case as when I enrolled I didnot include Cataract in my plan thinking its an old age disease but now I have been caught out. If I upgrade my insurance now there is 12 month wait period. That would increase my monthly insurance premium by roughly $100, plus the risk that my eyes may need to under the knife before the 12 month wait is over OR go overseas and try to get treated there.

If anyone knows the cost of private hospital for this procedure, please let me know.

Your thoughts are welcome, including any one who is unfortunate enough to be suffering or suffered with PSC.

Thanks all for reading!

Health & Beauty Health Fund

Comments

  • chumlee on 13/02/2018 - 15:23
    +3

    Is if not something that can be done in public hospital?

  • dcep on 13/02/2018 - 15:24

    what's the waiting time of public hospital ?

  • EvaEva on 13/02/2018 - 15:28

    Thanks chumlee and phunkydude for your response.

    It can be done in a public hospital but being a non-critical surgery for the hospital the doctor said it can take up to an year. I am not sure of the process, but I will find out for myself.

  • minniethemoocher on 13/02/2018 - 15:29
    -1

    My friend works for a ophthalmologist. When my mum needed a similar surgery my friend suggested that she go private and not public as you want to make sure an experienced surgeon is doing the work as you only have one set of eyes. If you go public there is a chance you will get a trainee doctor. My mum knew about her condition in advance and waited for the 12 months but she didn't have a day job. If it was me I would probably pay for an experienced surgeon in Australia. For most other health problems I would probably go public but your eyes IMHO are too important.

    • mbck on 13/02/2018 - 15:38

      How's the mum's experience and results?

    • djkelly69 on 13/02/2018 - 15:44
      +6

      If you go public there is a chance you will get a trainee doctor.

      Well everyone in every job was basically a trainee at some stage. They have to start somewhere.

      Seems somewhat unlikely you rock up on your first day of prac in a hospital and they tell you to go and do eye surgery… :-/

    • Bourb on 13/02/2018 - 15:47

      I'm certain that even if a trainee surgeon is performing the procedure, they would be under the supervision of a more senior surgeon.

      • djkelly69 on 13/02/2018 - 18:48

        Plus having done a lot of learning, practice, etc.

    • original15 on 14/02/2018 - 08:36

      Lol “don’t go public you’ll get a work experience kid operating on your eyes”

      Having friends that work in private and public I have 100% faith in public

      • minniethemoocher on 14/02/2018 - 12:36

        Well I personally, bar my Mum, I have no experience with eye surgery, I’m just going on what my friend said. I know people who work in private and public and have faith in public generally too. However my friend said that they work with a lot of patients whose results weren’t great after they had surgery by trainee doctors. She said once surgery is unsuccessful in your eyes, it’s hard, if not impossible to fix. Not such a big deal if your are retired, but a big deal if you are 44 and have a whole working career ahead of you.

  • wei13 on 13/02/2018 - 15:48

    You can easily ask the Ophthalmologist for a quote on how much it will be to do privately. They can usually give you an indication of costs involved, and you can weigh it up. I have a suspicion it will just be a day surgery, and you may not need to stay in hospital overnight.

    • BobD on 14/02/2018 - 07:58
      +1

      when I had this surgery at a private hospital (Albury) it was almost walk in and walk out. The surgeon and I were discussing fishing during the op. Later, when I had the other eye done at a public hospital (Benalla) it was still walk in, get the job done, and walk out after a brief wait. The second guy wasn't into fishing. In both cases I had to be driven home and the bandage was off the next day.

      • EvaEva on 14/02/2018 - 13:31

        Thanks, that gives me confidence :). Can I ask how much the private one cost you and the medicare rebate if any.

        • BobD on 17/02/2018 - 08:09

          This was about 8 years back so costs probably not relevant today and I have long since shredded my records. I can't remember Medicare amounts but I do recall the private hospital job was almost eye watering expensive as no private fund cover. I am guessing but I think it was net about $2.5K after Medicare. I was in a desperate hurry to get at least one eye working properly.

          The public hospital job was no cost and didn't even have to wait long. The hospital used the same specialist that I consulted. This stuff is easier in the country.

          I remember in both cases there was a long line of oldies waiting to get the job done. The actual meat slicing doesn't take long. It's all the prep and wait times that made it up to about 4 or 5 hours. They hold you around for several hours after to ensure that you don't have any adverse reactions. It is usual to see your specialist about a week after the op. They cover the eye not being worked on but you can still see blurry outlines through the one being sliced.

          I didn't have PSC. I'm far too old for that.

  • altomic on 13/02/2018 - 17:06
    +1

    should have read your private health insurance T&C's…..oh wait….sorry

    • vinni9284 on 13/02/2018 - 17:18

      Yep +1

      Clear as mud!

    • EvaEva on 13/02/2018 - 18:57

      Please read my post, I did not include cataract in my plan. It's not like I found it later

      • vinni9284 on 13/02/2018 - 19:58
        +1

        My previous response was directed as how their PDS is clear as mud. There are many exclusions or limitations that are abstract and are not clear on their PDS. This is across the board.

        Anyway, it is a big shame that you are paying $400 pm near $5K per year on Insurance that kicks you in the backside when you need them… and then they want additional $1200 to cover you for your condition and you have to wait 12 months for it! Then you may pay gap cover.. extra fees etc

        How much more do you need to pay?

        IMO, Insurance is the biggest rort. It is like a Pokie machine where you lose most of the times and at one time "luckily" win … however on their terms.

        I would call them and remind them of how much you have been feeding their coffers and they might at least reimburse you some money.

        Wishing you the best of luck

        • EvaEva on 14/02/2018 - 11:26

          Thanks vinni9284 for the wishes. My comment was not aimed at you but the person before who thought I didn't know my healthcare plan.

          I completely agree with you the health fund business here is bit of a scam here in Australia, you pay big bucks but don't get much back. I have been seeing eye specialists and they don't cover that too. I have lived in the US for a few years, the health insurance their is much better, they actually cover you whether hospitalising for consulting a specialist. I guess I will move back there ;)

        • vinni9284 on 14/02/2018 - 12:38
          +1

          @EvaEva:

          My ex-partner was with Bupa and also paying exorbitant amount of money per month like yourself.
          She needed a Nose operation however the specialist/surgeon performing the procedure was not on their approved list.

          Therefore Bupa wanted to pay her jack.

          She complained to them and reminded them of how much she was "throwing" away her hard earned cash to these coffers and they gave her some money back.

          Hence it is worth to push for some money/assistance.

          Yes. In your circumstance, it may be a black and white to upgrade but spending $5K a year warrants them to act on Empathy.. to give you something .. if that exists in this realm of blood-sucking organisations.

          Cheers

  • shaz0316 on 13/02/2018 - 21:02
    +5

    Hi mate.
    I'm an optometrist and refer a few ppl a day almost everyday for cataract surgery. From experience going private will cost you about $2500 an eye and you will get roughly half that back as a medicare rebate.
    Not worth it for you to pay extra premium on your health insurance for one eye but as you have seen(pun intended) a PS cataract can be aggressive so you might want to consider the implications if you get it in the other eye. All the best and if you need any advise you can pm me.

    • EvaEva on 14/02/2018 - 11:36

      Hey mate,

      Thanks for reading my post and giving your valuable feedback. I have the PSC beginning in the other eye too, I guess with a 50% rebate its not too bad after all, maybe I should just get it done.
      I tried to PM you but the site is throttling new posters. In your experience which hospital or doctor are the best in the business here in Sydney
      (assuming you are in Sydney)

      Many thanks again for taking the time.

      • shaz0316 on 14/02/2018 - 12:08

        I haven't practised in Sydney for years. What area do you live? I can ask done collegues and let you know.

        • EvaEva on 14/02/2018 - 13:31

          I live near Parramatta.

        • shaz0316 on 16/02/2018 - 19:59
          +1

          @EvaEva:

          Hi mate.

          So Dr.Ashish Agar @marsden eye clinic is paramatta has been recommended by some colleagues. I can't vouch for him personally nor do I know what his costs would be. Might be a start for you- sorry I couldn't help more- I can give you a good recommendation in hobart if you like :).

          All the best mate.

        • EvaEva on 24/02/2018 - 13:52

          @shaz0316: thanks mate

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