Private hhealth cover in Australia is a real pain in the @r$e!... ..because it is not simple!... I do not fully understand it, even after 10 years...and I doubt if anyone does....
Like the UK you can choose to join an equivalent of BUPA for private health cover. There are lots of different health funds to choose from, and lots of insurance plans under each fund.
The basic cover is "Hospital Cover" that provides funding toward a hospital admission. You can also opt for higher level of cover including Dental, Optical.... in fact, if a doctor can do it.... someone, somewhere will insure it. You can elect to have an "excess", that is, you will pay the fist $X of any cost, and the fund will pick up the rest (-ish)... and reduce your premium that way.
Also, there is Ambulance cover. Ambulances here need to be paid for, so many people take out an ambulance fund membership just in case they ever need to use one. You can have ambulance cover even of you have no private health insurance.
Medicare public hospitals are very good if you have an acute or emergency condition... you will be admitted, attended to, and made every bit as healthy as the NHS could do for you.... all under your Medicare levy and no additional cost.
However, like the UK, if you are non-urgent, there can be a waiting list. This can be lengthy in certain places for elective (i.e. non-urgent or non life-threatening) surgery.
Like the UK, if you have private health cover you can "jump the queue" and get into a private hospital or public hospital in a private area, or even in a public hospital in a public area ...after all, you *have* paid your Medicare Levy too...it just so happens you have a specialist who is prepared to put you to the top of his/her list.
That was the easy bit!
Now, how it works in practice!.....
Insurers are not stupid. For anyone taking out a new policy there is a declaration covering existing medical conditions... and very often a "Waiting Period"... which in effect means that you can take out dental or optical cover, but they won't pay out for the first X months for any treatment other than routine check-ups... because you might have known you needed dentures or new spectacles... or needed a brain transplant.. ...and just signed up the day before you ordered them! The waiting period can be anything from 6 months to two years depending upon the condition and the cover. (This does not generally affect accidental injuries or previously undiagnosed diseases or conditions).
Next thing... Like Medicare, the insurance companies will insure you for scale-fees based upon a rate agreed with Government and certain hospitals. If you chose Hospital X for your procedure and your fund has an agreement with them, then you are mostly OK. The fund pays the hospital. If you chose Hospital Y and your fund does not have an agreement with them, and they charge more than the agreed rate, you are left to pay what is called "THE GAP".
This is where the confusion starts big-time... Your specialist or surgeon may or may not have an agreement with the hospital or your fund. If he does, you are okay, because the hospital pays him and your fund pays the hospital... if not, you may still get a separate bill, that you send to your insurer, who will only pay whatever the scale fee is and you are left to pick up "THE GAP".
So.. If you are acutely ill, and have had no choice on where you are taken, and they ask if you have medical insurance, if you say yes it might cost you "Gap fees"... If you say no, you will get exactly the same treatment for nothing extra at all.
Some real life examples of this nightmare follow..... :?
