Cost of day surgery in a private hospital if health fund won't pay??

[hannah78]

My son needs to have an upper eyelid wedge incision to remove a lesion above his eye and we have booked to have it done in a private hospital. Unfortunately the health fund are refusing to cough up as the lesion has been there since March 2012 ( we have only been here since Jan 2013 and joined the health fund in March 2013) even though the diagnosis has only been confirmed in the last couple of weeks. It must be removed fairly quickly as it is growing and shedding viral particles into his eye, causing redness and irritation (so much so that his eye is almost shut most days). So my question is...does anyone have any idea how much the hospital fees will be? We already know the surgeon and anaesthetist will set us back at least $1000. I have phoned the hospital for a quote but there was no one available to speak to me, they will call me back.

 

Any advice would be much appreciated

[Guest The Pom Queen]

I would be trying to get it transfered to a public hospital asap if the insurance company won't pay out. If you can't then hopefully he won't have to stay in long we were quoted between $1,500 - $3,000 per day for our stay if the insurance company wouldn't pay out. Even with insurance we still had to pay for the consultants visits every day at $150 per day and I was in nearly 12 weeks in total. Thankfully we managed to get him to bulk bill. I would have thought the anesthetist alone would be $1000, mine was but then I am a complicated case.

As it's a day case hopefully everything will be ok and you won't need him to stay in overnight but if there are complications please be aware.

I hope your son gets better soon.

[Petals]

Usually the surgeon arranged everything and gives you the price of his/her fees, hospital fees and the anesthetist gives you his/her fee.

 

For removal of four wisdom teeth it for my son some years ago it was near to two thousand dollars all up.

 

For my mum having her cataracts done it was about two grand as well.

 

We are in Victoria and that is the way it is done here.

[Loopylu]

My son needs to have an upper eyelid wedge incision to remove a lesion above his eye and we have booked to have it done in a private hospital. Unfortunately the health fund are refusing to cough up as the lesion has been there since March 2012 ( we have only been here since Jan 2013 and joined the health fund in March 2013) even though the diagnosis has only been confirmed in the last couple of weeks. It must be removed fairly quickly as it is growing and shedding viral particles into his eye, causing redness and irritation (so much so that his eye is almost shut most days). So my question is...does anyone have any idea how much the hospital fees will be? We already know the surgeon and anaesthetist will set us back at least $1000. I have phoned the hospital for a quote but there was no one available to speak to me, they will call me back.

 

Any advice would be much appreciated

 

I haven't got a clue about the cost. However, if your health fund won't pay for it, have you considered going back to the GP and asking to be referred to a public hospital. Our experience is that if a child has an acute condition that requires immediate treatment then the public system reacts very quickly. Our daughter went to see the GP with a bad eye, was diagnosed with periorbital cellulitis and was admitted straight away to hospital for treatment. I am not sure where you are but here in Qld, how quickly your son would be treated in a public hospital depends on what category they are given by the hospital. Category 1 means that treatment is needed urgenty (within the next 2 weeks). Category 2 is within 3 - 6 months and Category 3 is 6 months onwards. Our daughter's adenoidectomy was deemed to be Category 2 and she had the operation within 6 months. It sounds like your son's condition is quite serious and I would expect a public hospital to prioritise treatment. Your GP should be able to advise you whether this is the case.

 

Hope this helps.

[starlight7]

I would try and go public if possible- I would have thought you would be classed as urgent so the wait shouldn't be too long- but you can't tell these days. I had a cataract done and I was only about $50 out of pocket but then I had to have a vitrectomy ( far more urgent matter) which costs over $1,000. No figuring really

[hannah78]

Thanks everyone. I did go back to the GP who advised that if he referred him to a public hospital he would sit in a long queue to be seen (even though he agrees that it needs to be operated on with a matter of urgency). He printed off a letter that I can take to the Sydney Eye Hospital with my son and ask to be seen there. I will have to plead poverty (his suggestion), explain the situation and hopefully they will be able to help. At the end of the day if we have to pay then so be it, he needs it done in the next few weeks, so if the eye hospital can't offer that we will stick with the private system and get it done in 2 weeks time when we already have an appt booked.

[Quinkla]

You will never be able to know how much health care will cost in advance. This is one of the reasons the Australian health system sux. The best you will ever get is a consultant telling you his fee - but then you have to pay for the hospital, he nurses, the anaesthetists, the medicines, the equipment...

 

The system also sux because even if you have insurance, it doesn't pay for what you need or, if it does, it only pays a small fraction of the end bill. Plus, if you ever got really sick, you would lose your job and you wouldn't be able to pay the health insurance fees any more.

 

Australia does many things very well, but healthcare isn't one of them.

[Guest littlesarah]

One of the difficulties with healthcare, including elective surgery, is that when things don't go exactly to plan it can take a lot more time and money to fix them that was originally anticipated. In the public sector, that just means the taxpayer picks up the tab, and worst case scenario the waiting list gets longer. In the private sector, more time and money to fix leads to a bigger bill for the patient. I don't really see why it wouldn't be possible to go with a fixed price for straightforward cases, but of course, then there would be a built-in margin to account for those unusual but costly complications.

 

To be fair, if you lost your job and were unable to afford private health care, the public system would/should kick in. The Australian public system can work well, and I have personal experience of it doing an excellent job (not just medically, but from the perspective of empathy and dignity).

[Petals]

I do know that in Victoria you can have a doc of your choice when a public patient as this happened to my daughter when she was diagnosed with type 1 diabetes. We did not have health insurance but she still saw the pediatrician of our doctors choice and was admitted to public hospital with him looking after her. Myself I had an urgent condition I was seen by a private specialist in private rooms who made the appointment for the surgery in the public hospital. He did not do the surgery whoever was on that day did it but I went in within three weeks. No health insurance in those days.

 

It really all depends on the GP and who they refer you to. We are fortunate to have one who had many specialist friends that she trained with so we have always been referred easily and quickly.

 

I know I needed a breathing test at the public hospital and I got one straight away.

[Que Sera Sera]

Give the public system a try, no point shelling out money you don't need to .