Surgery options AU vs UK heeeelp

[krmcc]

My partner dislocated his shoulder doing Tough Mudder (...) and was referred to a specialist by our doctor who confirmed he needs surgery to attach the tissue back to the bone. We have just received the quote back, and for one night in hospital its going to cost us over $10,000 for the surgery! We've been told shoulders aren't covered by the medicare system in Australia.

 

Does anyone know what the average wait time is back in the UK at the moment for getting something like this done through the NHS? It seems like our best option would be to fly back to have the procedure done.

 

Any help/knowledge would be appreciated!

[Tickled Pink]

Are you PR here? or temp visa?

[Guest]

I don't think you could just fly back to have the procedure. You would need to be under a GP, get referred, see specialist, be assessed etc. Then the wait time for the OP.

 

I am not sure you can just just pitch up and have an non urgent op if you are not resident in the UK, even if you are a citizen.

[Guest littlesarah]

I don't think you could just fly back to have the procedure. You would need to be under a GP, get referred, see specialist, be assessed etc. Then the wait time for the OP.

 

I am not sure you can just just pitch up and have an non urgent op if you are not resident in the UK, even if you are a citizen.

 

Even if you are resident, the chances of being able to have surgery within a short time frame are not too high for most types of surgery. Assuming the 18-week wait still holds good, you'd be looking at being in Britain for 6 months just waiting. The other thing I'd consider is that with a specialised surgery, it's best to have a surgeon who has a lot of experience and interest in that particular body part and type of procedure. I guess if you're able to be in the UK for 6 months on a waiting list you could consider that option, but if you're classed as resident in Australia you may not qualify for NHS treatment anyway (though I don't know how carefully they check, but with computerised records and data-sharing it may be easier for Trusts to figure these things out).

[krmcc]

Thanks for the replies. He's on a 461 visa, we've been here just gone a year now so he would be classed as a resident now.

 

We were considering calling our doctor and seeing if its possible to forward on the scans and specialist notes direct to his to see if this will quicken the process but as you've mentioned this might effect our option for getting the NHS as we wouldn't be classed as a resident

[Loopylu]

My partner dislocated his shoulder doing Tough Mudder (...) and was referred to a specialist by our doctor who confirmed he needs surgery to attach the tissue back to the bone. We have just received the quote back, and for one night in hospital its going to cost us over $10,000 for the surgery! We've been told shoulders aren't covered by the medicare system in Australia.

 

Does anyone know what the average wait time is back in the UK at the moment for getting something like this done through the NHS? It seems like our best option would be to fly back to have the procedure done.

 

Any help/knowledge would be appreciated!

 

Hi

 

I did a double take when you said that you had been told that Medicare does not cover shoulder surgery and so I checked the Medical Benefits Schedule and there are numerous entries for different types of shoulder surgery. Perhaps the procedure your partner has been referred to is a new procedure only done privately? However, I would be surprised if this was the case. I would go back to the GP or an alternative GP and say you cannot afford to go private and that you want to be referred to a public hospital for the surgery. The only downside of this route is that there could be a very long waiting list. My MIL waited 5 years for her hip replacement and only got it when she fell over and shattered her hip and they had to fix it!

 

The other thing you need to consider is whether you are on a 457 visa and therefore only have reciprocal cover under Medicare which only covers acute conditions/medical emergencies. If this is the case, then you probably would not qualify for the surgery under Medicare and would have to go private in Australia. If you are on a PR visa, then you should be able to get the surgery on Medicare.

 

As the others have said, if you have been out of the UK for a while you would probably not be habitually resident and therefore would not qualify immediately for free NHS care if you tried to go back to get it done.

 

Hope your partner gets the op soon and makes a good recovery.

[Rupert]

Thanks for the replies. He's on a 461 visa, we've been here just gone a year now so he would be classed as a resident now.

 

We were considering calling our doctor and seeing if its possible to forward on the scans and specialist notes direct to his to see if this will quicken the process but as you've mentioned this might effect our option for getting the NHS as we wouldn't be classed as a resident

 

I don't think there is any might about it, the NHS is for residents not citizens, so your OH would not qualify at the moment. You would need to move back, I guess you have to weight up the cost of that ($ and otherwise) versus the cost of the operation in Australia.

[AJ]

a 461 is a temporary visa, that is probably why it is not covered by medicare

[Petals]

Another way is to take out private health insurance, and wait 12 months and then have it done, however you will probably be up for a few thousand dollars gap plus your premiums. My knee cost me over 5 thousand taking into account the gap and the insurance premiums.

 

Shoulders are very awkward to get right so really it comes down to whether you want anyone to do the op or a person who specialises in shoulders. I must admit my new knee is wonderful and I have had no bother and I do not mind the fact that I paid to make sure.

[starlight7]

The only thing with taking out PI is that it is a pre-existing complaint- sometimes they have rules stopping you from doing this

[Gbye grey sky]

The only thing with taking out PI is that it is a pre-existing complaint- sometimes they have rules stopping you from doing this

 

They definitely have rules for this. They wouldn't pay out leaving you even worse off.

[NickyNook]

They definitely have rules for this. They wouldn't pay out leaving you even worse off.

 

And the rule is that they won't pay out for the first 12 months after taking out the policy. After that time, the pre-existing conditions don't matter and they can be claimed.

 

http://www.phio.org.au/facts-and-advice/the-pre-existing-conditions-rule.aspx

[kimsdu]

Uk may not even offer the surgery... The NHS are very reluctant to put you forward for surgery if at all avoidable. I was in a very similar situation but lived in the USA, i had seen doctors there and they said i needed surgery for a rotator cuff injury on my shoulder as it kept dislocating, Also i have worn down the tissue on my socket which makes it slide in and out easy. Anyway i couldnt do this in the USA as cost a fortune.. Over $100,000 and i had no insurance to cover it.. So i flew back to the UK after 12yrs in USA made an appointment at my Drs who referred me to a specialist... WOULD NOT GIVE ME SURGERY!! This went on for months.. and second opinions chats with physios all told me NHS really dont want people being put in for surgeries unless absolutley necarssary as it cost so much.........All im saying is check that this surgery is definitely needed because what the NHS class as needed is different from what the docs may have told you here.

 

 

Edit to say... 4 yrs on i never did have the operation , I did 6 months physio then gave up i just ate painkillers and ibruprofen, gave up my job in the States as i needed a good shoulder for my job.

Edited December 9, 2013 by kimsdu

[Gbye grey sky]

And the rule is that they won't pay out for the first 12 months after taking out the policy. After that time, the pre-existing conditions don't matter and they can be claimed.

 

http://www.phio.org.au/facts-and-advice/the-pre-existing-conditions-rule.aspx

 

That is interesting, thanks for the link. Private health insurance is more stringent and difficult to cover pre-existing conditions I think in the UK. Wouldn't a pre-existing condition affect your premium though?

[NickyNook]

That is interesting, thanks for the link. Private health insurance is more stringent and difficult to cover pre-existing conditions I think in the UK. Wouldn't a pre-existing condition affect your premium though?

 

No, everyone pays the same premium for the same cover. No medicals required usually.

 

They make their money from the premiums you pay during the period where you can't make a claim.

[Quoll]

As a temporary resident I dont suppose you have private health insurance lurking in the background do you? I know one woman found that her husband's employer had been paying it - that was a 457 visa though. Worth checking with the employer.

 

You wont get NHS cover unless you move back.

[krmcc]

Under the reciprocal they say that surgery isnt covered if its not classified as being medically necessary and can be completed on return to the UK. Even though it means he can no longer swim, play rugby, has to be extremely careful at work lifting heavy objects (basically rules out anything from his private life he was doing before) but then by the sounds of it wouldnt be covered under NHS to even have it done on a brief return. You've raised a very good point Petals, the specialist who hes seen and would do the surgery only works on shoulders and seems to really know his stuff, which is a huge difference to what you get in the UK. I guess you get what you pay for right? If only it wasn't $10,000...

 

I hope you all have full cover health insurance!

[Guest]

I know it's after the event now, but if he does make a return to sports and physical events in the future while you remain in Aus it may well be worthwhile him taking out insurance to make sure he is covered should another injury occur.

[caramac]

Under the reciprocal they say that surgery isnt covered if its not classified as being medically necessary and can be completed on return to the UK. Even though it means he can no longer swim, play rugby, has to be extremely careful at work lifting heavy objects (basically rules out anything from his private life he was doing before) but then by the sounds of it wouldnt be covered under NHS to even have it done on a brief return. You've raised a very good point Petals, the specialist who hes seen and would do the surgery only works on shoulders and seems to really know his stuff, which is a huge difference to what you get in the UK. I guess you get what you pay for right? If only it wasn't $10,000...

 

I hope you all have full cover health insurance!

 

 

Why is it a huge difference from what you'd get in the UK? There are orthopaedic surgeons here who specialise in different joints here - it's exactly the same, without the price tag! One of our friends specialises in knee surgery and another in backs. There are regional 'centres of excellence' for different specialities - orthopaedic, neuro, cardiac..... and the there are smaller 'general' hospitals which can do the less complex stuff.

[Petals]

The difference is that doctors do not work for the government health department here in Aus they work as small businesses or for larger private enterprises. Therefore they can charge what they want and if they are very good at what they do they reap the rewards. Some specialists do not work in the public system at all. Some do do lists at public hospitals though as they like to use the public hospital facilities.

 

Its not the NHS here and its not anything like the NHS and most of the docs who migrate are pleased its not the NHS as they can make as much money as they like.

 

People have to stop comparing the health systems, do Brits that go to America compare, I doubt it because they know its different, just because we do not have a completely private system and the gov picks up some of the costs for some of the people its not the same as the NHS. Personally I like the fact that I can get several opinions from specialists if I like and I can select who I have do the operation, that is what having private health insurance is all about. I had it when everyone had to have it and then gave it away for many many years and only took it out now my engine is wearing out. When one's engine is wearing out and bits and peaces is the time that one needs competent surgeons who are specialists in different bits and bobs.

 

If I was in the UK I would probably take it out too so that I did not have to wait on a list to get a chance to have an operation.

 

Lets face it as the years draw in do we have time to wait, who knows. :wink:

[caramac]

The difference is that doctors do not work for the government health department here in Aus they work as small businesses or for larger private enterprises. Therefore they can charge what they want and if they are very good at what they do they reap the rewards. Some specialists do not work in the public system at all. Some do do lists at public hospitals though as they like to use the public hospital facilities.

 

Its not the NHS here and its not anything like the NHS and most of the docs who migrate are pleased its not the NHS as they can make as much money as they like.

 

People have to stop comparing the health systems, do Brits that go to America compare, I doubt it because they know its different, just because we do not have a completely private system and the gov picks up some of the costs for some of the people its not the same as the NHS. Personally I like the fact that I can get several opinions from specialists if I like and I can select who I have do the operation, that is what having private health insurance is all about. I had it when everyone had to have it and then gave it away for many many years and only took it out now my engine is wearing out. When one's engine is wearing out and bits and peaces is the time that one needs competent surgeons who are specialists in different bits and bobs.

 

If I was in the UK I would probably take it out too so that I did not have to wait on a list to get a chance to have an operation.

 

Lets face it as the years draw in do we have time to wait, who knows. :wink:

 

But this is just like the UK. There are drs who work solely in the public sector, those who are purely private and those who do a mix of both (and make as much money as they like). You can choose your dr whether or not you choose to go privately and you can choose where in the country you go for that treatment, providing you pay for the travel. Most people choose to stay close to home for practical and social reasons.

Just because someone is working in the private system doesn't make them any more competent than someone who works in the public system. My husband is a dr who has worked fairly extensively in both countries (and is heavily involved in collaborative research between both) and there are more similarities than differences. He is very specialised and can practice and develop his interest equally well here, or there. He chooses to work solely in the public sector because he feels very strongly that his expertise has been paid for by the public and therefore everyone should have equal access to him, regardless of their ability to pay.

He did work in a private clinic in Sydney, but the patients' costs were covered by Medicare, so anyone could access his service.

 

 

My problem is more with the idea that you get better treatment in a private setting - I simply don't believe that to be true. Yes, you might be able to get your elective surgery done more quickly and see your dr whenever you want, which is great, but having worked in a private hospital, I would rather be somewhere where there are drs on call overnight, there is more likely to be an icu and where the staff have compulsory cpd. We know several people who qualified years ago, work solely in the private sector and go to conferences put on by drug companies in order to say they've completed their cpd, but never really do any proper updating or further study. One friend makes an absolute fortune, but his approach is very old fashioned and out of date. He brings his patients back week after week , so they think they're getting wonderful attention, but they're not making any headway with getting better. Those patients (and their insurers) are getting very poor value for their money, so the ability to make money doesn't necessarily depend on being very good at your job.

My oh does a large amount of teaching - to med students, junior drs, gps and colleagues and he seems to be in demand despite his lowly status as a public sector medic. :smile: