Best Surgeon / Doctor...

Every time I speak to anyone that has had surgery or seen a specialist they seem to have seen "the best of the best" or "the top guy in Australia" ect.

The best bloody dr in Australia must rotate on a daily basis.

^^^ seen many pro athletes go for the public system lately?

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Mackerel said..
Best Surgeon / Doctor...

Every time I speak to anyone that has had surgery or seen a specialist they seem to have seen "the best of the best" or "the top guy in Australia" ect.

The best bloody dr in Australia must rotate on a daily basis.

/\ /\ /\ Yep he is a busy man......apparently.
I think its just something that oldies say, after a hip operation etc, that have forked out 10's of thousands of dollars on "health insurance" for years, now trying to justify the cost to others around them.
"Oh but it was done by the best surgeon on earth, so definitely worth every cent" lol You hear it said so much its laughable.

My last op was done in a public hospital, for free, by the..... ummm..... errrrr.... the second best surgeon on earth???.

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Mark _australia said..
^^^ seen many pro athletes go for the public system lately?

Pro athletes aren't known for their smarts, generally.



So I just tried to make a claim with my private health fund for having a cancerous mole removed. Cheap, simple, saves the life of their member.

Nope. Can't claim anything.

Reason being I didn't get the procedure done as an inpatient where medicare paid 75% of the cost.

Think about how poor a system this is. Do you pay more in private health or medicare levy? How much of the cost is paid for the former and the latter?

It's all very reassuring to have be forced to have private health cover, but the actual value is very, very, very poor. That's the point people are making.

The money would be better in the public system. I'd rather lose "mandatory" private health and just pay a little more for the medicare levy.

Why pay through the nose to improve the private health system (buy doctors' porsches) when we could pay to fix the public system, that it was as good or better than the private system?

If you have the coin you are mad not to have private health. Health is without question one of the most important thing in my life. Life can go pear shaped real quick with a debilitating injury. I am prepared to pay for the right to have it fixed....like right now pleAse. Even if it's not "good value" it's worth having cause it's about quality of life.

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evlPanda said..

So I just tried to make a claim with my private health fund for having a cancerous mole removed.




dont worry mate plenty more fish in the sea, had to break up with my missus not long ago ;)

Similar to that my wife has had not once, but twice, parasites that had to be removed in hospital. They were that large that they were clearly visible and could be felt moving under her skin. We grew quite fond of them and decided to keep and raise them.

So when my private health care is covering me from a $20,000 bill they only cover me if Medicare covers 75% of the cost. Else I have to pay for all of it myself.

So so they are "protecting me" from a $20k bill, but only if they have to pay less than 25% of the bill. < Read that again.

Private health covers the gap, sometimes, and quite often not all of the gap. They only cover you for a percentage of the overall cost. The bulk is covered by Medicare. However, you are made to feel like they are covering most or all of it.

It is all confusing on purpose.

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evlPanda said..
So when my private health care is covering me from a $20,000 bill they only cover me if Medicare covers 75% of the cost. Else I have to pay for all of it myself.

So so they are "protecting me" from a $20k bill, but only if they have to pay less than 25% of the bill. < Read that again.

Private health covers the gap, sometimes, and quite often not all of the gap. They only cover you for a percentage of the overall cost. The bulk is covered by Medicare. However, you are made to feel like they are covering most or all of it.

It is all confusing on purpose.

This can not be true, is it??? If this is the case why would the government offer medicare levy discounts and tax reliefs to people who choose to have private health insurance.

The whole thing is a complicated method of creating an industry, and growth, out of something that already exsists.

it's clearly spelled out here, in as confusing a way as possible. www.privatehealth.gov.au/

If you visit a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist - this applies whether or not you hold private health insurance. If your doctor bills Medicare directly (bulk billing), you will not have to pay anything.


Read the what is covered page.

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KiteDevil said..
The whole thing is a complicated method of creating an industry, and growth, out of something that already exsists.

it's clearly spelled out here, in as confusing a way as possible. www.privatehealth.gov.au/

If you visit a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist - this applies whether or not you hold private health insurance. If your doctor bills Medicare directly (bulk billing), you will not have to pay anything.


Read the what is covered page.

If you hold private health insurance and go into hospital you will find Medicare will only cover you for 75% of the scheduled (MBS) fee. Your private fund will pay the 25% difference up to the scheduled fee. Most of the time the scheduled fee will not be what the doctors/specialists/other service providers charge... which they are quite entitled in their own right to charge what they deem to be a fair and reasonable charge for the services rendered. What people don't understand is that with private health insurance and the "no gap or known gap" scenario when you go to hospital.. is that the Drs have already entered into an arrangement with the funds to accept a payment directly from the funds for their services.. the fund will then claim what would normally be claimed back from Medicare.. this will leave a difference that the fund has to suck up... could this be what is contributing to the big costs of private health insurance? Also.. seriously.. if you have a life threating illness you are going to be treated in a public hospital anyway.. and then it will be your choice to use your private health fund.. which will give you Dr of choice if they have access to that hospital.. either way in the public system.. you wont have any out of pocket expenses. Going to a private hospital.. a whole other kettle of fish... and that is where it seems hard sometimes to justify the cost of paying into a fund.. plus the medicare levy..

I work in health care.

My doc told me private health cover is a waste of money.

Pay the instalments off your mortgage instead.

Draw it back if you ever need to pay for health costs.

Recently had a DVT which developed into a bilateral pulmonary embolism (think Jonah Lomu and funeral).

Ambo to hospital. Intensive care for 8 days. Best cardiologist in Sydney, best intensive care specialist in Sydney.

Total cost…..zippo. Medicare is awesome.

Further treatments have cost me minimal but these people saved my life for free.

We have one of the best healthcare systems in the world.

And it costs us about 1.5% of our income….most likely less.

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saltin said..

evlPanda said..
So when my private health care is covering me from a $20,000 bill they only cover me if Medicare covers 75% of the cost. Else I have to pay for all of it myself.

So so they are "protecting me" from a $20k bill, but only if they have to pay less than 25% of the bill. < Read that again.

Private health covers the gap, sometimes, and quite often not all of the gap. They only cover you for a percentage of the overall cost. The bulk is covered by Medicare. However, you are made to feel like they are covering most or all of it.

It is all confusing on purpose.

This can not be true, is it??? If this is the case why would the government offer medicare levy discounts and tax reliefs to people who choose to have private health insurance.

Why? To make it confusing of course!

There are a number of tiers and depending on your income, age and family situation you will receive a percentage back, a rebate, of your private health insurance premium (even that word is confusing), ranging from 0% to 37%. Most of y'all are going to get 20-30% back.

https://www.ato.gov.au/individuals/medicare-levy/in-detail/private-health-insurance-rebate-and-medicare-levy-surcharge/?anchor=PHIincomethresholds#PHIincomethresholds

But to quote BUPA:

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BUPA said...

For all medical service charges from doctors while you are a hospital inpatient, Bupa will cover the 25% gap between what Medicare reimburses you or your doctor and the Medicare Benefits Schedule (MBS) fee for that service.

www.bupa.com.au/health-insurance/common-questions/i-am-a-member/medical-gap-scheme

Medicare covers most of and sometimes all of the cost of the procedure.

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But with private health I get to choose my own doctor!

How the **** do you choose your own doctor?

Is there a website with star ratings or something. I know absolutely nothing about who is a good or bad doctor and would not even know how to start nor trust anyone that says they know how to figure that out, if you even have the opportunity to do so in the back of an ambulance while you're struggling to breath!

THANKS to all replies I'm more confused than before. I'm starting to think medicare picks up a fair amount if not all the bill ,and I could use the more to pay the mortgage and redraw if I need to . same line of thought as bigwave Dave

I'll add my current experience....

I'm currently in hospital with my two kids who had both Tonsils out and Grommets in ears, I'm having foot surgery in a few weeks and my surfers ear drilled out a few weeks later.

I have private insurance. It's been good that I have just found the best surgeons and hospitals and got it all sorted. Costs saved are probably a few thousand for each procedure (don't know exactly but it's saved us a bit). HOWEVER I reckon if we didn't have insurance and saved for these things, we would have managed.

Walking into the hospital today I was still in two minds if private insurance is worth it.....

Until I spoke to the lady sitting across from me now. She told me that her little girl had a brain tumour in January this year. Over a couple of weeks, private health insurance covered $500,000 of bills. They had the best of everything and sounds like the little girl is on the mend.

I'm sure public will sort you out in that situation somehow but from that story, for me with little kids, yes private health insurance is necessary.

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Jono77 said..
Over a couple of weeks, private health insurance covered $500,000 of bills.

They covered the gap. Public health covered most and perhaps even all of that cost.

Oh for... now these are the ads I see on SeaBreeze.

If you have an accident or some other medical emergency you will be treated exactly the same with medical insurance or without....they only difference maybe after ICU with insurance you might have a more private room......but that is only if there is one available.

Insurance can help....after the critical situation is fixed, you can move to "nicer" private hospitals etc..but if the stay is extensive for rehab, public generally have better facilities.

You do need insurance at times.....if you travel overseas, or work overseas.

I got sick while OS in a developing country, eventually falling into a coma, medivac insurance covered the $100,000+ cost of the charted jet, on on board doctors and nurses....landed in Australia, 3 weeks in hostpital - medicare covered everything else.

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Mackerel said...
Best Surgeon / Doctor...

Every time I speak to anyone that has had surgery or seen a specialist they seem to have seen "the best of the best" or "the top guy in Australia" ect.

The best bloody dr in Australia must rotate on a daily basis.

I know exactly what you are saying as everyone reckons that they have the best but I have a good example of when this mattered. With my foot, I was referred to a surgeon. They asked what type of surgeon I wanted and it came down to a general surgeon (sorry, no technical terms here!!) who may or may not have seen my issue before or see a very expensive specialist who is covered by insurance who know my issue inside out. I was lucky that I could opt for "the best" in this situation.

I ve never had the insurance have had quite a few stays in hospital scans and surgery in the public system allways been treated well and in a timely fashion.

Have paid for private in other situations and to get the "best guy" there is usually a wait any ways because they have a long list of bookings

creepy

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djt91184 said..

Have paid for private in other situations and to get the "best guy" there is usually a wait any ways because they have a long list of bookings

They are all better than each other, that's how people always get "the best guy".

Makes people feel better. They have no idea how good he is. Who would?

My wife

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loftywinds2 said..
Unless you live in Elysium, insurance is only for the rich and foolish

Insurance is a rip-off, right up until you wish you had it.

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mkseven said..
Something is really not right with that industry, it would be interesting to see the premiums paid vs claims compared to say car insurance industry which seems to be doing ok & how many pay $2000+ per year on that.

As a base consideration premiums are offset against potential of claim, do professional sports people pay higher premiums than normal folk?

Hardly a reasonable comparison, car insurance doesn't pay out if you blow the motor by feeding it McDonalds and beer for 35 years and it needs a complete rebuild