I have private health hospital and extras cover.
My husband has extras only but needs an endoscopy and a colonoscopy. Which he's been quoted will cost over $3000 for in a private hospital.
I'm guessing the answer is no, but does anyone know a way around wait periods for these?
Was thinking something along the lines of of we combined into a family plan would we get around the wait times as I've already served them?
Thanks in advance!
colonoscopy and endoscopy was around $1k
For only $1000, are you sure they didn't do your colonoscopy and then use the same tube camera for your endoscopy? š
I had mine at a private day place (near Liverpool) about 15 years ago and it was just over $3,000 too.
use the same tube camera
No idea, maybe they did, I was unconsciousā¦
Itās been a number of years so might be needing another one in a few weeks and I will update with what the current quotes are.
No idea, maybe they did, I was unconsciousā¦
Ha.. When I went in, it was only for a colonoscopy. But they also did an endoscopy while I was asleep too. So I joked and asked… "you didn't use the same tube, did you?" lol
How do you know they did not use the same tube in your $3,000 procedure?
well, I didn't wake up with a bad taste in my mouth! š¤£
North shore tax perhaps?
Perhaps. I would ring a few day clinics in other areas and see if theyāre cheaper.
I just did a quick google search and according to finder it ranges from $1300-$2200 if I read that page correctly.
Go in as a PUBLIC patient.
Wont cost you a brass razoo
Better way to wait out the public wait then wait and pay as a private patient
Wow really? I had a cystoscopy (which I DIDNT NEED AT ALL, the Specialist was just in a rush to do procedures and make money as i later found out as other people had reported the same thing about this surgeon / specialist) and that was like 3k including excess hospital and was just a couple of hours and then i was out.
Iām interested to know the answer, cos if there is a way to avoid the waiting period, it entirely defeats the purpose of having insurance
Ie if you can just wait for a problem to arise then buy your āinsuranceā afterwards
Best way is to be in public waiting list and $3k isnt that much either, even with private you still have to pay for huge gap. Most you get covered is private hospital stay.
I've just been given a choice. Wait 6-12 months on the public waiting list for a colonoscopy, or not have to wait and pay $1000.
He's thankfully on the public wait list and has been told it would be about 3 months which isn't that bad.
But I'm still freaking out over here at the bit where he was told it "could" be cancer.
For me it was like "oh it's probably a bacterial infection" and bam cancer. Anyway $3000 seems excessive. I'd be seeing if your GP can refer you elsewhere. There's plenty of good specialists around that don't charge an arm and a leg.
If you were in Victoria I could recommend some good ones.
OP, Try this^ Get referral for different specialist.
Not necessarily correct in all cases.
Had the same procedure done privately twice this year and paid 0 gap. There are no gap providers. The excess (which for me is covered by work) also covers the calendar year, so should you need another one in the same year then it is completely free when using a no gap provider.
Also located on the North Shore so feel free to inbox me if you would like the name OP.
If you're in Melbourne, endoscopy place in western suburbs charged about $500 without insurance a year or so ago (endoscopy and colonoscopy together) . Let me know if interested and I can find their details. Then they have the additional costs depending on what's required during the procedure (removals, biopsy etc).
Also consider that not all h.insurance has coverage for colonoscopies etc, do you know if it's included in your current plan and how long is the wait period?
Imo There's no way around the waiting list for your situation unfortunately. Can you go public instead and at the same time he can get the hospital cover and see what comes 1st?
We're up in Sydney.
I think public will probably come before a 12 month wait for private health.
I'd shop around if you don't want to wait for public. I've found that prices vary a lot between different places. Do a google search and call a few places for prices. Honestly $3 sounds extremely high if they're just looking and checking etc. Or fly to Melbourne, have the procedure and enjoy a holiday break at the same time. Still cheaper than $3k.
We're actually down there for a weekend in January!
Yeah I'm with you - I got both done start of the year at the Centre for GI Health in south East and it was like $600 so shop around
Ok i have similar topic question.
For hip replacement (cost without cover total could be $25k including hospital stay), but we join the top hospital cover, serve 1 year waiting period (total cost under $3000 a year) and I heard the private health will pay for everthing? How they can afford a customer like me? And after operation next year i will drop my cover to the lowest.
How they can afford a customer like me?
From the millennials who dont make a claim
From the high prices we all pay every month. And the extras we pay for and rarely use (speaking for myself here).
This speaks for the population, as at September
https://www.apra.gov.au/sites/default/files/2022-11/Quarterlā¦
Yes, a minority of the people account for the vat majority of health care costs. Health insurance is quite different from car insurance, and insurers cannot charge the heavy users more.
Just be careful they don't sting you with it being a "pre existing medical condition" and refuse to pay out. Read the pds carefully.
u might need to find a doctor to diagnose you after you take out the insurance or waiting period (not sure which one)
(*I'm guessing here… I dont know how these things work but those are the things I'd consider for myself if I were in your shoes)
Might be screwed if the current doctor has already put it on the MyHealth record.
Opted out of MyHealth in the beginning.
@CyberMurning: I haven't played with it too much so I can't tell you exactly, but if you log into Medicare through MyGov, it'll probably be quite easy to see where to click.
@bobbified: Hmm i loginto my gov, can see my healthbis one of the services i linked. Bit when i click go to service, it asked me to select create record. So im opted out?
Maybe i was opted in long time ago so i have the service linked.
@CyberMurning: That sounds about right. If you haven't opted in, it'll prompt you to create a record. You can probably also confirm with your doctor (whether they use it) next time you're there.
@bobbified: My Health Record switched to an opt-out model so if you never opted out then you probably have a record.
Pre-exisiting conditions are not refused - they are covered after a 12 month waiting period.
The only thing that can exclude your pre-existing medical condition is if the actual condition is excluded from the policy. For example, some policies exclude pregnancy or mental conditions.
Exclusions should not be confused with the waiting period for pre-existing conditions (12mths).
Correct. Pre exist = 12m waiting
Non = 2m waiting (some generous provider)
@CyberMurning: Did exactly this process a couple of years ago. Signed up, waited 12 months, scheduled operation and made claim.
No issues with fund, and whilst there were still a lot of out of pocket costs (hospital excess, travel, anaethetist excess etc) it was still about 10% of the quoted price.
@Switchblade88: Also hip operation? When i look at one (HIf) there are choices of $500 or 750 or 1000 excess. If i choose 500 excess plan thats all i have to pay right? 500? Or that is for every type of claim? Omg so sneaky
@CyberMurning: Similar enough for the claims process for the insurer, but not a classic socket replacement and thus was more costly.
The problems come when you realise you're dealing with several separate entities - hospital, surgeon, anaesthetist all make separate claims and use various Medicare item numbers, not all of which will be fully covered by Medicare or your fund.
Best method is to get written quotes with item numbers, then take those figures to your (potential) health fund and see how much they'll cover so you know where the gaps are.
Your 'hospital excess' as quoted by the fund (usually $500/$750/$1000) will go to the hospital on admission, but then we had a $500 copayment to the anaesthetist and $3000 to the surgeon out of pocket because of the specialty of the surgery.
@CyberMurning: Supposed to be, as long as through one of the health funds preferred providers. My understanding is that you pay once per health fund year, but Im not sure if you pay again if it's a different problem region, my understanding was once per year only. I'll let you know later in 2023.
This isn't a thing in Australia. Even pre-existing conditions will always be covered (under the correct policy) after 12 months.
It doesn't work that way in Australia. By law, after a year, they have to cover your hospital stay as long as the complication is offered.
I pay $1500 a year and recently they forked out over $15,000 for me. At least now moving forward I'll be cheaper in the long run had they not forked out that much and I went untreated.
People who dont have private dont realised that private insurance does not cover 100%.
Your $25k or OPs $3k in total, there are so many component and within insurance policy, each component has max limit that you can claim per year. Best thing is to take a quotation and send it to insurer and see what you would get back.
Hospital stay aka accommodation is what you get most out of private, so if you having a day surgery, this is nothing.
And then there are bits that not included, unless you pay premium. Just similar to flood cover in home insurance.
Ex Health Fund employee - no you must serve out the wait times. No way around it.
On a financial side of it, if it's going to cost $3,000 going public, how much is the insurance cost for your husband for the year? Is it worth him even having cover? Looking into the future though, after he has served the waiting period he wont have to wait for anything that's covered under that level of hospital cover.
We've been intending on getting him hospital cover for a long time, he's very accident prone lol.
We just figured now he actually needs something done maybe it's the right time to look into it.
My doctor once referred me for a colonoscopy and I got a quote from a private place in Bondi Junction that charged for the doctor, the anaesthetist and the theatre. It wasn't as much as $3000 but it made me baulk (and this was maybe 15 years ago). So I asked my doctor if I could do it through the public health system, and he said he couldn't see why not and referred me to Prince of Wales hospital in Randwick. The wait was a few weeks and it cost 0$.
We've got the public referral but 3 months is what's been estimated.
I guess I was lucky. If it's just routine because, say you're a certain age, then 3 months isn't a deal breaker, but if there are symptoms that indicate the procedure(s), I wouldn't want to wait that long either.
Unfortunately symptoms are present, with severe persistent pain.
Once youāve got cover, you only pay your excess for your first hospitalisation, and that covers you for any subsequent hospitalisations for that calendar year. It's worth it if you have a chronic condition and as you get older. Last year, I recouped the cost of ten years' premiums with several procedures and hospitalisations.
If your doctor works in a public hospital as well as private, it is possible to get on the list as a private patient in a public hospital. I did this for a colonoscopy a couple of years ago. The public wait was a few months but, as a private patient in the public hospital, the wait was eight days. Cost a bit of course, but nothing like paying the full price for private. Just a thought.
Thanks for that. I think definitely worth us asking.
Donāt only go by on-site quote costs. Think there is a 1% levy for every year uninsured since early 90s.
Which hospital was that quote for? The San?
There is an endoscopy centre in pennant Hills you could also enquire with. I went there years ago and the doctor I saw was very good, but didn't go with that place this time as the doctor I was referred to didn't instill me with confidence.
It was for the Mater.
He's on the wait list for Northern Beaches.
Whoa, I paid about $350 for endoscopy at a day clinic somewhere near Auburn, NSW. No insurance, all out of pocket. This was in 2014 though.
I am shocked at these quoted prices!
Wow, seriously colonoscopy is 6-12 mths wait??
Is this real? I thought is common procedure and govy always asked male over 40s to go take one.
And quick google seems to say 3-5 weeks wait.
My insurance didn't cover mine 2 years ago, it was a 12 month wait for public as they did'nt consider me high risk, and as my doctor was quite concerned so we decided to go private,cost was between 2-3k.
He's not in his 40s
wife is getting colonoscopy and gastroscopy tomorrow at Victorian Gut centre (Bundoora, Melbourne) and total cost they quotes us is $700. we don't have PHI and waiting for public was not an option
Seems like Victoria is the place to go for this kind of stuff
Isn't it insurance fraud if you get caught working the system? You shouldn't be able to take out insurance on an existing condition.
be aware that there may also be a "known expense" rule - where, if they can prove that you knew about the expense coming up (e.g. mentioning it on an open forum, like say… OzBargain) they can still deny the claim up to and including 12 months.
as others have said, read the Policy - carefully.
What? Please point to a policy where this applies. This is not America. I have never seen a reference to a known expense rule or similar.
I can know that in 3 months or 12 months I have medical services coming up and there is no requirement to inform an Australian health insurer about these.
The policy is that pre existing conditions are not covered for at least 12 months.
If you're posting on OzB about it, you can hardly turn around in a few months and say "Oh, this is totally new".
The claim was made by @harrywwc about a so-callled:
"known expense" rule - where, if they can prove that you knew about the expense coming up (e.g. mentioning it on an open forum, like sayā¦ OzBargain) they can still deny the claim up to and including 12 months
That is different to the pre-existing conditions aspect you are referring to.
My policy with Australian Unity does not require an excess payment for Day Procedures.
That may be for the hospital charge, but there still would be excess or out of pocket expenses for the doctors/medical procedure
One provider I used before would waive waiting periods if you are joining via a corporate code. Perhaps check if you can join using his workplace? It may even be cheaper.
I'll check this out. Thanks!
They waive them only for extras. That has been my experience with corporate promo codes.
If it was not discovered as a pre-existing condition, you would skip wait periods.
If it was not discovered as a pre-existing condition, you would skip wait periods
The claimant would still need to disclose any pre-existing condition at the time of claim.
2 months WP if it can be considered as Non Pre existing! Application to be submitted for that which includes notes from the Doctor and Surgeon. If declared Pre existing then 12 months. No other rules apply
for the pre existing can i just serve 12 months without declaring or i still have to declare upfront ? (im 100% sure can and will wait 12 months)
If you complete 12 months then No one cares if its Pre Existing or New condition. People take cover sometime telling their issue and then plan their surgery for 12 months after
ok thanks. yeah actually the specialist is the one suggested just take 1 year before
Read your funds policy. When my wife went on to my plan she still had to serve waiting periods.
Also, unless he has some medical complications $3000 seems obscenely excessive. My last privately funded colonoscopy and endoscopy was around $1k at a colonoscopy day hospital.