Is There Realistically Any Difference between Private Health Providers?

LLunarWhisper on 14/03/2024 - 19:08

Hi all,

For the people who have switched private health providers or who work in the industry- Curious to know why you are with the insurers you currently have and if you switched- have you noticed a difference in your total out of pocket cost when you switch?

Looking at the big funds such as BUPA, Medibank, NIB and HCF, it does seem that they basically cover all the specialists and hospitals in a major city like Sydney.

The only thing I can really differentiate is their pricing (on the same plan) and their %hospital/gap/known r cover - using the ombudsman 2022 report- you can note that all the big funds have different specialities (i.e HBF 99.6% known gap whilst Medibank only has 97% known gap)

In summary - looking to know which insurer would give me the lowest total out of pocket costs.

Health & Beauty Health Insurance Insurance

Comments

  • sumyungguy on 14/03/2024 - 19:20
    +7

    They're all pretty much the same… aside from premium costs, included/excluded services, agreement vs non-agreement hospitals, excess options, hospital service waiting periods, extras covered, extras limits, extras waiting periods, ambulance cover, etc.

    • soan papdi on 14/03/2024 - 19:42
      +4

      Apart from the sanitation, the medicine, education, wine, public order, irrigation, roads, the fresh water system, and public health … what have the Romans ever done for us?

      • LunarWhisper on 14/03/2024 - 21:57
        +1

        thanks for note- I did an average on the gap covers in NSW - would you ever consider changing to a provider that has a higher % of no/known gap cover?

        See data based on the ombudsman’s report here - https://imgur.com/a/PO5MqJY

        • sumyungguy on 14/03/2024 - 22:36

          There are more than 30 insurers offering a mind-boggling array of policy options. Seeing as you're likely to use private health for elective procedures and allied health, I suggest you make a guess as to what services you expect to consume and compare coverage for policies at the price point you desire. I'm currently with Qantas/nib - they started out targeting affluent price-insensitive customers but now offer policies that have broader appeal.

      • BewareOfThe Dog on 14/03/2024 - 22:22

        Syphilis?

  • djones145 on 14/03/2024 - 19:45

    they all have minor differences to make it harder to compare
    i know the limits and sub limits for say dental and for eyes is slightly different ( not enough to matter much, like between 10 to 25 dollars on what you can claim)

    for hospital i know previously medibank was the only one that covered husband/partner bed when wife was in hospital with bub. minor stuff

    • LunarWhisper on 14/03/2024 - 21:46

      Good to hear that about Medibank but i read news that since last year they wont be covering for any accidental costs while you are IN hospital which is a shame as medibank is cheaper than my current provider BUPA

  • DingoBilly on 14/03/2024 - 20:00
    +1

    Beyond the costs and what they cover, you'd probably find the following helpful which details complaints, how likely the fund is to pay out and other figures:
    https://www.ombudsman.gov.au/publications-and-news-pages/pub…

    • LunarWhisper on 14/03/2024 - 21:51
      +1

      thank you,

      I am not too sure what ‘how likely the fund is to pay out’ implies- my understanding is that if you have served the applicable waiting periods and your doctor deems it necessary- why would the health fund not pay it out?

  • AustriaBargain on 14/03/2024 - 20:02

    I hard doctors like the highest Medibank cover for their family cover, a few hundred a month. Tiny gap on many services, which is less of an issue for a doctor salary anyway.

  • KillBotFactory on 14/03/2024 - 20:08

    Some hospitals have preferred suppliers. You might get a few extra perks depending on where you think you'll go.

  • Baysew on 14/03/2024 - 20:32

    i.e HBF 99.6% known gap whilst Medibank only has 97% known gap)

    Maybe being a not-for-profit fund like HBF compared to a shareholder owner fund like Medicare may result in more favourable coverage and claims.

    • Trance N Dance on 14/03/2024 - 20:49

      What's HCF's?

      • LunarWhisper on 14/03/2024 - 21:48

        HCF has 89.1% no gap and 97.6% known gap in NSW for 2021/2022

    • LunarWhisper on 14/03/2024 - 21:42

      True, but a bit shocking how HBF’s no gap % is only 87.2% whilst BUPA’s is 90.9% in NSW

      You would think that being not for profit but give u higher no gap % than a for profit like BUPA..

      • resubaehtgnolhcs on 14/03/2024 - 21:57
        +1

        Being not for profit, does not mean that the organisation is run efficiently

  • dtc on 15/03/2024 - 08:56

    Some run their 'provider networks' (or whatever they call them), where if you have a procedure with their doctors or in their networked hospital they cover almost all the costs; but outside of that network you barely get anything. Like the $43 refund on the $1900 anesthetist bill I recently received…

    • LunarWhisper on 15/03/2024 - 14:44

      oouch, not only do you need to worry about out of pocket for your doctor gap but also the out of pocket when ur in hospital…

      May i ask if there was a reason why you were treated in an out of network hospital? In a major city like sydney, i can see that BUPA basically covers all the large and medium size hospitals in greater sydney.

      • dtc on 15/03/2024 - 19:03

        Surgeon operated only at an out of network hospital. It was a very small hospital (I had never actually heard of it before the operation) but that was the only one he used. Didnt think about it until it was already done (was an ACL replacement)

Login or Join to leave a comment
Login Join