So I ruptured my ACL & tore my MCL too according to my MRI. According to my doctor you can potentially wait for years in the public Medicare system.
Can anyone tell me which private health insurance would be best for this surgery?
Completely Ruptured My ACL & Have No Private Health Insurance. Please Recommend a Provider
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The 12 month exclusion period doesn't mean you are covered for pre existing conditions after 12 months. It means that anything that occurs within your first 12 months is deemed a pre existing condition.
Pre existing conditions are NOT COVERED by private health insurance. Oddly enough you need to have insurance before the injury.
This is incorrect. This is the case in the US as far as I know.
In Australia, after 12 months of Hospital coverage, assuming you have a level of cover that covers the surgery you need, you will be covered for pre-existing conditions.
Source: PHI employee for 14 years.
Correct.
According to my doctor you can potentially wait for years in the public medicare system. Can anyone tell me which private health insurance would be best for this surgery?
Get yourself on the public list now! You'll be waiting a year for PHI as there is a 12 month waiting period.
Go to work tomorrow and trip over a box that shouldn’t have been on the ground.
Geeze, tough crowd
Yep people today are very uptight. It was just a joke and not an actual recommendation
Very serious world we live in now and can’t joke around
Plenty of people would post that seriously.
@Randolph Duke: I know someone on another team at one of my comps, who actually did this at work to claim workers comp, I think it might happen more than we think especially injobs where it is feasible to get injured .
@quick-dry: Most sport insurance are crap, they only have it as i believe legally they have to have it. But in terms of what they cover and what you get back is not that much and its also after everything else possible has already been used. Theres also a lot of hoops you have to jump through, i guess he felt it would be much better through workers comp as his work will know its not his fault since it happened at work, he will get covered for income as well as for the surgery and recovery etc.
@Randolph Duke: I know a sociopath who did that seriously - faked an injury at work, then was off work on paid leave for 18 months
takes a Major R Soul to pull that off tho'
People do this, and don't realise that insurance companies will assign investigators to this and if you get caught committing fraud, you're absolutely wrecked.
Not only will you be up for going to court for fraud, you'll be blacklisted in the industry.
@coffeeinmyveins: No different than all the other people claiming the disability pension because they are sad and anxious. Is it right? No. But this is the world we live in. So many sponges out there.
@digitalbath: I have relatives that for every decade I have worked, they have worked 1 day
Frustrating as you get genuinely disabled/ill people that could get double the money if we got rid of the people who are unwilling rather than unable
I could have a drink with this guy
Just 1? Tough crowd.
Many!
Do people really think they can sign up for private health insurance and get expensive treatments covered instantly? That's… not how it works.
You mean I can't discharge maybe a $50k liability for signing up for PHI, spending $500 a month's worth of cover, and then cancel once the surgery's done?
I could maybe hang on for three months if it meant some Qantas points, but I really don't want to … you know … actually pay for this stuff.
Insurance companies hate this one simple trick!
Yes, they do.
You'd be surprised how stupid people are when it comes to insurance. Nobody, and I mean nobody, actually reads the PDS or terms of service either.
Not only will this be marked as a pre-existing condition with a waiting period, they may even just simply exclude it entirely from ever being covered.
Frustrating when we first signed up for the wife who was pregant…months before they said we needed to….
Baby born premature, baby not covered for a week and needed humidicrib etc.. $$$$$$$$
When I severed my ACL and tore the meniscus in 2000 it was $8k out of pocket which was about how much I'd put aside from self-insuring the previous 8 years. I got insurance after that.
Dr Neville Rowden at St.George Knee Clinic (he's still working) was the surgeon.
Do the physio beforehand or the recovery will take forever.
Get on the public waiting list so the "apprentice" can do it or pay the bucks
I did have a few workmates back in the day that came into work on Monday and slipped on the stairs quite early in the day. They all seemed to have weekend soccer in common.
Start the physio exercises now. The reason why professional athletes have surgery the next day is because they haven't lost movement in the knee. The surgeon won't operate until you have full movement back into your knee as of you will never get the movement back post surgery.
Get your knee moving back and forth, should be heaps of videos on YouTube with exercises that you can do.
Some people go years without the surgery although this limits their ability to twist, walk on uneven surfaces, bush walk, etc.
Couldn't agree more about starting the physio exercises asap. Regardless of whether you sign up for private health or wait for public, you want full range of motion asap.
I do have to disagree with the last part about being limited in activities by not having the surgery done. There's a lot of recent studies done about it not being 100% crucial. I'm biased in that I didn't get mine repaired the most recent time I tore it (I've had the same ACL reconstructed twice already), but I am not limited in what I can and can't do, as long as I stay on top of exercising and do specific physio exercises for specific sports if I do want to start them.
Get on the public waiting list so the "apprentice" can do it or pay the bucks
This is not actually the case. Experienced surgeons, even surgeons who run a Private Practice, can and do work in the Public system.
can and do work in the Public system
… and supervise the junior doctors and so ensure nothing goes wrong.
yeah when my gall bladder turned out not to be an easy surgery, because it had started to necrosis, the expert in the room took over from the trainee. teaching hospitals are great.
the guy in the bed opposite me in recovery had a much worse time with a similar starting condition. he had been in a regional hospital for the initial surgery that had also gone badly but there wasn't a more qualified surgeon in the room to take over. his recovery was a month, with lots of complications, instead of my week.
teaching hospitals are great.
All public hospitals in Australia are teaching hospitals
Yep.. frequently the surgeons doing private also do public
Agreed.
I had my ACL reconstructed in 2008 in a public hospital by a surgeon who I also had consulted with privately before. At the time he was one of the leading Vic knee surgeons.The only differences were the choice of screws and disposable tools used (ie. i have steel screws rather than the fancy ones) and it was also a lucky dip as to if I got him, or any other surgeon.
Sensible comments here, esp. re the self-insurance. The only downside with getting insurance after 1 Jul 2000, assuming you were > 30 is the added LHC surcharge.
I don't know the stats but I think the odds are quite high you'll get a registrar not a consultant if you go public and the supervisor is not always there for the procedure but available if needed.
My stepson is now a consultant orthopod but fessed up to one mistake during his training which will probably require a revision after a couple of years. He was always in the top 5% of his cohort so if he stuffed something up then most registrars probably have as well.
However I think the odds of having a problem in public health are still very low
Research paper on public vs private knee and hip outcomes
https://pubmed.ncbi.nlm.nih.gov/22834486/Satisfaction rates were high in both public and private patients (approximately 90%) at 6 and 12 months, but private patients were less likely to be satisfied after adjusting for the strong effect of patient expectation. For both hip and knee cohorts, no between-sector differences were found in either the magnitude or rate of improvement in Oxford score or quality of life post-operatively.
If you are in Perth, I'd suggest HIF.
Use the Referral Link @ https://www.ozbargain.com.au/deals/hif.com.au
With the Public Hospital you will be looking at more than a year, so as long as the Waiting Period is less, Private is worth the investment.
Yes I'm in Perth. Any particular reason why HIF?
Hi,
I had looked around and found HIF cover was the best for my needs and competitive.
HIF has a local Perth presence, that means you can phone them or go in to Stirling Street in Perth and talk with a local.
They have an App which means that you can lodge claims quickly and without paperwork and delays.
Ask them for details on waiting times on their cover and what extras you might need to cover Physio or Hydrotherapy.
HIF has a local Perth presence, that means you can phone them or go in to Stirling Street in Perth and talk with a local
I haven't had any need to walk into a health insurer's office in a long, long time.
They have an App which means that you can lodge claims quickly and without paperwork and delays.
They all do!
Ask them for details on waiting times on their cover
It's all covered here: https://www.hif.com.au/help/hospital-cover/do-waiting-period…
As with all Australian health funds, you are required to wait 12 months before claiming on any pre-existing condition.
Huh?
Imaging sitting on the side of the road, asking random strangers for medical advice. It'll be better than what you get off the internet. Old mate is just throwing random jibberish.
But unfortunately the crowdsourced answer you're getting in this thread is right, sign up to PHI now and wait the waiting times plus get into a public waiting list ASAP. There's no good solution here. I broke my toe years ago (really broke, three fractures) when I didn't have PHI, the options were to pay out the wazoo to get it fixed, join the waitlist where I'd wait so long that it'd heal and they'd have to re-break my toe and set it properly in surgery or hope like hell that taping it straight worked.
Fortunately, the tape worked.
Imaging sitting on the side of the road, asking random strangers for medical advice. It'll be better than what you get off the internet. Old mate is just throwing random jibberish.
In fairness to the OP, they didn't ask for medical advice, they asked about private health insurance.
Private health insurance doesn't do surgery, surgeons do
Medicare doesn't do surgery, surgeons do…………
You morons have downvoted this person but they are correct. Private Health Insurance is prohibited by law from paying for the surgeons fee. They only pay for the hospital stay.
Medicare still does their rebate on the surgeons fee.
Private Health Insurance is prohibited by law from paying for the surgeons fee.
That doesn't seem to be the case.
Indeed, you are correct. The earlier unnecessarily rude poster is way off the mark.
The details:
It says, in the link you provided, that the:
health insurer will pay the additional 25 per cent (if you are eligible for benefits for those items under your health insurance policy).
For context. that section of the page you link to is referring to: 'each of the doctors and health care providers involved in your care'. It goes on, 'This can include medical specialists, surgeons, assistant surgeons, anaesthetists, physiotherapists, pathologists and radiologists'.
I think the unnecessarily rude poster above is referring to surgeons' fees when the surgeon sees you in their practice rooms. These fees are not paid for by the health fund. Those incurred in hospital are paid for by the fund, though, note:
[D]octors and health care providers are free to charge more than the MBS fee and many do. … If your doctor charges above the MBS fee, you may have to pay the extra amount.
@YesPleaseThankYou: No, you are being unnecessarily obtuse. If the surgeon charges you over the Medicare fee then you are out of pocket for all of that.
Yes, so they are limited to the Medicare fee. If your surgeon charges you $10,000 and the fee is 1000 your private health insurance. Will give you $250
@deme: Actually, some covers with some funds will pay more than that for some surgeons, it's usually called gap cover and should mean no out of pocket fees for the surgeon.
Completely Ruptured My ACL & Have No Private Health Insurance.
Just go through the public system. It's free…………..
This. I've had private health for years and just had an ACL reconstruction. Cost me about $6,000 out of pocket, not including the premiums I have paid over the years.
In saying that, I'm a desk jockey that doesn't require an ACL to work, so there was no lost income.
Cost me about $6,000 out of pocket
Maybe you need a better policy…
Or maybe I had better surgeon….
jv this is pretty common. I've had a couple of surgeries in the last few years, and no matter my annual premium and cover, the surgeons can charge above the expected AMA price for a particular surgery, of which most PHI will only cover up to that limit. After this, everything above that $ is out of pocket, which is why over time PHI is becoming less and less attractive.
If you want to solve the issue of out of pocket $, you have to call around and "doctor shop" for actual surgery prices. This is the world we live in now.
you have to call around and "doctor shop"
Which happens with pretty much every other product and service.
@jv: morebunnings below added some good detail, as another way to get around the out of pocket cost with particular surgeons. It's been the same experience for me. It's a very weird medical insurance network.
Except with medical things, I don't think we should have to shop around for anything… unless you want a particular surgeon for a particular reason unrelated to cost.
For more experimental or new surgeries where someone can basically command whatever they like (for a time, until it becomes common practice), that's a little different.
What was your wait time?
I didn't have a waiting period. Held private health insurance for 17 years and this was the first hospital claim over that time.
I had a similar experience with my ankle surgery and private health insurance. About $2.5k out of pocket, which was about 40% of the surgery cost.
I didn't know this at the time, and wasn't explained by any of my doctors or specialists, but you shouldn't just go to the specialist that your doctor recommends. You need to call your insurance, explain what your issue is and then go to a specialist that is in their network. Then they cover a lot more than what I got covered.
If the specialist you want doesn't work with your isnurance, you can switch to a different health fund that does work with them and there is no waiting period, as long as the level of cover in both plans is the same for that type of surgery.
I didn't know any of this at the time. Could have saved my self a few grand.
Just had my shoulder stabilisation done within 3 months of referral in public system in Canberra. Couldn't believe it.
It's all about where you live, each health district has its own waitlist.
That's cool, I live on east coast and saw specialist in Canberra. Surgery done at Queanbeyan. I do remember referring doctor saying it was shorter going to specialist in Canberra than waiting for one on coast.
Travel overseas and get it done faster. Might be same cost as yearly insurance here.
https://www.sbs.com.au/language/hindi/en/article/australian-…
Neil McLean found out would have to spend close to $100,000 if he wanted his teeth fixed in Australia
What were they doing?? Fitting up a jaw made from meteorite ? and diamonds for teeth?
im actually a dentist, a decent chunk of the cost is because the materials needed to fix teeth are very expensive, a small chunk to pay overheads like rent, receptionist and the dental tech and the last majority chunk, to pay for my mercedes amg.
Haha… It looks believable after reading the last bit of the statement.
I got a quote for $3.5k for one broken tooth. $3.5k x 32 teeth = $112k so this definiteley checks out.
If anyone is wondering, i paid the guy $300 to pull the broken tooth out and leave a gap. Way cheaper.
You should’ve gone to a better dentist. I paid about $500 for my dentist to rebuild my front tooth after I smashed it. The only way I know the difference between them, now, is the undamaged one had a ridge at the back I can feel with my tongue. They both look natural. It was a really ugly jagged break too.
Jake D: Actually that implant quote is on the cheaper side
Agreed! All up with extraction, temporary plate, bone grafting and installation of a titanium post implant for an upper jaw incisor came to be about $12k. For one tooth! It was a very well regarded surgery though and 15 years on I must say it was worth every penny.
So is not outside the realm of possibility that one could rack up up $100k in dental work if they had a particularly bad set of chompers.
Let me give you some useful advice… you need to fill that gap with a tooth asap. Over time, your jawbone will physically shrink due to the lack of pressure being applied via chewing forces.
Get a cheap implant.
@watwatwat: It's top row, so no jaw bone. it's been 10 years and the only noticable change was that all my other teeth are straighter now as there is more room for them.
What were they doing?? Fitting up a jaw made from meteorite ? and diamonds for teeth?
Yes
Get one that covers Rehab too, just in case. St Lukes does
What does the procedure cost privately? What sort of gap payment would you have for PHI? How much have you saved not having PHI for years?
This is the question I was looking for. How much does paying $2000 and waiting for a year save you on the cost of the private hospital and surgery?
What were you doing at the time of the rupture?
Scrolling through OzBargain. He turned the chair too quick whilst seeing a sinister looking kid outside.
If you can't wait the year on a private list and public will likely take longer than a year. Shop around for a price from a surgeon. Cry poor etc.
Request a release from your super to pay for it or take out a personal loan.
I had my PCL done by public and it was the worst surgery I have ever gone through. YMMV
Hi OP.
I ruptured my ACL last year as well and this was my experience. Note that i did have private insurance at the time.
- went to the GP who provided a referral for the MRI (at no cost), which confirmed that my ACL was fully ruptured
- went to the emergency department at the public hospital to try to get the procedure for free. was told that the waiting time is approximately 2 years. It took them 4 months to send me a letter for my first specialist appointment
- went to an orthopaedic surgeon who is affiliated with the private hospital close to my house. it took 2 months for the knee to go back to an operable position (it was badly twisted) and I had the operation 3 months after the injury.
I was quite naïve and never realised the extra costs involved, even if i had hospital cover with my private insurance. These are the out of pocket costs i had to incur:
- 6 physio appointments pre surgery: $180
- 2 appointments with surgeon pre surgery: $300
- Surgery costs: $2500 (surgeon, hospital excess, assistant surgeon, anaesthetist). Again, these are the out of pocket costs
- Crutches and pharmacy: $100
- 10 physio appointments post surgery: $300
- 2 surgeon appointments post surgeryTotal out of pockets costs close to $3,500
OP, before you pay 1 year + worth of private insurance plus the above costs, you should evaluate if the ACL reconstruction is urgent. I paid for mine as i wanted to start playing again ASAP. Any surgeon would tell you that ACL reconstructions are optional. You can still walk but cant do sharp turns, whilst waiting for your public hospital surgery date and save the above costs. If that is something you are considering, you need to go to the public hospital as soon as possible to get the ball rolling.
I am not sure if the above helps you but i though it would be prudent to warn you of all the costs to be incurred on top of private insurance costs. All the best in your decision.
P.S the recovery is also very long. it will me approx 1.25 years since the injury until i can play again.
Any surgeon would tell you that ACL reconstructions are optional.
P.S the recovery is also very long. it will me approx 1.25 years since the injury until i can play again.
These are both excellent points.
ACL can and does heal naturally. And whether you go surgery or natural you have a long, hard road of recovery.A completely ruptured ACL will rarely heal naturally as its in 2 pieces.
Also, 9 months is the typical time from Surgery to return to play - depending on sport and level.
went to the emergency department at the public hospital to try to get the procedure for free
Um, why?
This. The GP should've sent a referral to the outpatient's department, which would've resulted in:
It took them 4 months to send me a letter for my first specialist appointment
i was in excruciating pain as my knee was badly twisted as a result of the injury. The GP asked me to go to the ED
Then the GP was clueless or lazily passing the buck. That wasn't an emergency. They should have referred you, and prescribed Endone until the appointment. That's an elective surgery. Hospitals don't have surgeons on standby for walk-in ACLs.
I've seen it rehabbed without surgery via physio several times. May as well strengthen it while you wait
same with shoulders and sportsmen returning in even better shape than they were before after tearing tendons, muscles. have also seen ppl get surgery and its gone south and no coming back from that 1
surgery also only gives you a " better chance" of it not happening again.
if its completely severed though then yea need to reattach
I would google and ask your gp which knee surgeons are good in Perth. Who does the profession sports players. Ring up the surgeons clinic and find out the costs and then call up the health funds and see which one would have the least out of pocket expenses for that surgeon. Some may be part of the health fund preferred programs so could be very minimal or no out of pocket expenses for the surgeon. Only the hospital excess.
OP you might miss this but this is the right approach.
From experience I think choice of surgeon is the biggest advantage of having knee recos in your private health insurance.
There is a big gap between the best specialists and some of the public system surgeons
I had an acl done using a hamstring with a world leading surgeon and was walking within an hour of the operation. I've seen some public jobs where they did a full zippier job straight down the keen that looked terrible and took ages to recover from.
Standards may have improved the last 10 years but it's worth considering.Another tip would be to ask the preferred surgeon which hospitals they operate in. Their fees, and the hospital fees, out of pockets can change substantially for the choice of hospital. My wife had a surgery few years back. They surgeon offered us robotic surgery at no cost as it was new equipment at a Cabrini Malvern. BUPA were not going to cover the robotic surgery fees from the hospital. Due to robotic surgery, the trauma from the surgery was less and recovery was way quicker and painless too.
There's a movement towards considering conservative treatments for ACL - i.e. no surgery if you aren't doing activities putting significant strain on ACL. When i partially tore my ACL - I managed it conservatively - just physio
If you are in VIC, I can recommend Nigel Hartnett, knee surgeon
Be aware of exactly what the Operation will provide you with and what the long term prognosis is. I tore my medial meniscus and the surgeon explained the couldn’t repair it only trim it to avoid the pain. Then Covid happened in the middle and by the time I could’ve been operated on the pain wasn’t so bad. I didn’t bother with the Operation. Find out if you are going to cause further damage by waiting.
A lot depends on how bad the damage is. Surgeons will always have a natural bias to surgery - it's the "when you have a hammer everything looks like a nail" effect. In fact the better the surgeon they are the more biased they are likely to be.
It is up to you to make sure it really is a nail by talking to people - the physios, your GP, a second specialist opinion. So make sure you have your own copy of those scans to show people.
Yeah I like to add it was the surgeon who recommended I managed it without surgery too
Username checks out, found the limit of their knee :/
Just walk into the ED in Royal Darwin Hospital, will be fixed within a week!
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You're going to be waiting a year for a pre-existing condition. Sign-up and wait!
Source: https://www.health.gov.au/topics/private-health-insurance/wh…
I have not seen any insurer offer less than 12 months for pre-existing conditions. Happy to hear otherwirse.
Note: different rules apply to extras, which is not what is being discussed here, unless you're going to need physio, home nursing, or something like that.
See also: Commonwealth Ombudsman publication Waiting periods for private health insurance