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paulswin

Medicare covers what?

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Just to clarify, public hospitals are funded by the state governments and not Medicare, but yes you would be treated for free in them. Some procedures done in public hospitals are covered by Medicare and in these instances you may be asked by the hospital if you would be happy for it to go through Medicare so the hospital can claim additional funds from the Federal government. You won't have to do anything for this to happen except sign a form. Waiting lists for none life threatening public procedures can vary greatly depending on the department that will see you and the area you live in.

 

Public hospitals are run by state govts but jointly funded by state and commonwealth govts (including funds from Medicare levy) to operate the Medicare scheme. It is the Medicare scheme that makes possible and guarantees universal free treatment for medical services and accommodation costs in public hospitals.

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We have private insurance which has come in handy to get seen quickly when needed, however we are more than happy with the care Medicare has provided. For example, a few years ago a lump was found on my thyroid gland by a Medicare Dr who sent me for a scan covered by Medicare. The dr was anxious to rule out cancer and sent me to a private endo surgeon for further investigation. He asked if we had insurance as this would mean I could be seen immediately which he thought was imperitative and on medicare the wait would have been longer than he was happy with. I saw the surgeon privately, thankfully he ruled out cancer and I now see him through Medicare for regular scheduled check ups as I can wait for those.

 

It doesn't seem fair that someone without insurance or who couldn't pay would have to wait but for me personally it was invaluable to be seen quickly in this case.

 

I find it wonderful that on medicare you can choose your Dr. We moved house recently and have visited a few local GPs when we needed to, before we chose which practice to go to. Feeling confident in your GP is essential in my book. I also see a different GP for one issue in which she specialises and travel to the other side of the city for this as there is no one in our area. She gives me her test results to give to my normal GP to keep her in the loop too. It all works very well for me and I have several ongoing health issues.

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Yes there are many of examples where people in the public system get better service, which is good, but the private system would quickly die if it wasn't "better".

 

I think that's a completely false conclusion. Private health isn't necessarily better, it's just that the private health insurers spend a lot of money on advertising, i.e. propaganda.

 

I've had several experiences of public vs private for the same ailment. When I first went to a specialist here for my asthma, he was rubbish. Luckily someone told me about the clinic at Royal Prince Alfred, and the treatment there was outstanding AND free.

 

Then I had a throat problem and lost my voice. The first (private) specialist told me - after four visits - that I had throat cancer and booked me in for an op. When he found out I had no insurance, he said, "oh I'll refer you to a public surgeon". I was going to object, but I didn't like his manner anyway, so I accepted the referral. The public surgeon took one look at my throat, gave me some tablets and I was cured in three days.

 

I've also known several women who've had babies on either the public or private system and their experiences aren't much different, except for the cost!


Scot by birth, emigrated 1985 | Aussie husband applied UK spouse visa Jan 2015, granted March 2015, moved to UK May 2015 | Returned to Oz June 2016

"The stranger who comes home does not make himself at home but makes home itself strange." -- Rainer Maria Rilke

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My issue with your use of the word better has nothing to do with the service and everything to do with the clinical capability of the people doing the actual medical procedure. While private health may give you a better service in terms of having a nice room etc what it cannot guarentee is that the clinicians actually doing the medical procedure are any better than those doing them in the public system.

 

Now your main concern when having an operation may be how nice the rooms are, or whether the person on reception is friendly, but my concern is more about whether the surgeons are any good at what they do and what will my health outcomes be like. People opt for private because it will mean they can have elective surgery done sooner rather than having to wait. Whether the actual surgery done privately would be better than that done in a public hospital may or may not be the case.

 

Yes, but the chances of your surgery being performed by a trainee surgeon or a surgeon not particularly experienced are far greater in the public system. Admittedly, some very senior surgeons work in the public system as well as having a private practice and if you can get one of them to operate on you publicly, then well and good.

 

However if you want to guarantee that you get an experienced surgeon of your choosing (which means you can choose the best surgeon for the job) operating on you then you have to go private.

 

In the public system you get who you're given. They might be really good, they might be really inexperienced...

 

I would always choose private in order to pick my surgeon. Got nothing to do with the curtains or the food. I just don't want some rookie practicing on me. :wink:

Edited by NickyNook

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Public or private, the health system in Australia sux.

 

The problem is everyone wants a fantasic system without paying for it. It sux because it doesn't have the funding and what little it gets is wasted.

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Moving to Adelaide in June and I'm looking at medical insurance at the moment in preparation. I have psoriasis and am on immunosuppressant medication which requires periodic blood tests and specialist visits to monitor side effects on an ongoing basis. Would this be covered by the Medicare system as it is by the NHS?

 

I currently get my medication by (paid) prescription on the NHS, should I be looking for a particular box to tick on the insurance comparators? Specifically, I have no idea what “Non-PBS Pharmaceuticals” means.

 

I hope somebody can help advise me :notworthy:

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Moving to Adelaide in June and I'm looking at medical insurance at the moment in preparation. I have psoriasis and am on immunosuppressant medication which requires periodic blood tests and specialist visits to monitor side effects on an ongoing basis. Would this be covered by the Medicare system as it is by the NHS?

 

I currently get my medication by (paid) prescription on the NHS, should I be looking for a particular box to tick on the insurance comparators? Specifically, I have no idea what “Non-PBS Pharmaceuticals” means.

 

 

http://www.pbs.gov.au/pbs/home

 

I'm sure you've already discovered that you can't get cover for a pre-existing condition for at least 12 months.

 

Yes your blood tests will be covered by Medicare but make sure you tell your GP you're not covered yet for specialist visits, because many GP's will send you to a private specialist automatically.


Scot by birth, emigrated 1985 | Aussie husband applied UK spouse visa Jan 2015, granted March 2015, moved to UK May 2015 | Returned to Oz June 2016

"The stranger who comes home does not make himself at home but makes home itself strange." -- Rainer Maria Rilke

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Moving to Adelaide in June and I'm looking at medical insurance at the moment in preparation. I have psoriasis and am on immunosuppressant medication which requires periodic blood tests and specialist visits to monitor side effects on an ongoing basis. Would this be covered by the Medicare system as it is by the NHS?

 

I currently get my medication by (paid) prescription on the NHS, should I be looking for a particular box to tick on the insurance comparators? Specifically, I have no idea what “Non-PBS Pharmaceuticals” means.

You pay for prescriptions - more than in the UK. The PBS is the scheme that allows some medicines to be supplied at a subsidised rate; some medicines are not available on PBS and you have to pay full cost which could be moderate or could be astronomical.

 

I don't know about regular appointments with specialists wholly on Medicare. I think you have to pay for your own blood tests either way, and if you have private insurance it will cover only [some of] the cost of inpatient care. You still have to pay to see specialists out of your own pocket and get a portion of it back from Medicare. By way of example, I booked an appointment yesterday to see a specialist. I will have to pay $250; Medicare will give me a rebate of $128.30; insurance will pay me nothing.

 

Unwellness in Australia is expensive.


Feb 2010 Prospective Marriage Visa | Nov 2010 Temporary Partner Visa | Nov 2012 Permanent Partner Visa | Jan 2015 Australian Citizenship

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I have regular blood tests and scans and frequent appointments with a specialist all on Medicare with no out of pocket expenses. At first i was sent private , so as someone says above when you first go to a GP for a referral state you want to use the public system. The biggest down side was waiting almost a year to actually get my first Specialist appointment , after that though they are regular.

 

Cal x


If you don't go after what you want, you'll never have it. If you don't ask, the answer is always no. If you don't step forward, you're always in the same place...

If you get a chance,take it, If it changes your life,let it. Nobody said it would be easy they just said it would be worth it...

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You pay for prescriptions - more than in the UK. The PBS is the scheme that allows some medicines to be supplied at a subsidised rate; some medicines are not available on PBS and you have to pay full cost which could be moderate or could be astronomical.

 

I don't know about regular appointments with specialists wholly on Medicare. I think you have to pay for your own blood tests either way, and if you have private insurance it will cover only [some of] the cost of inpatient care. You still have to pay to see specialists out of your own pocket and get a portion of it back from Medicare. By way of example, I booked an appointment yesterday to see a specialist. I will have to pay $250; Medicare will give me a rebate of $128.30; insurance will pay me nothing.

 

In Sydney, most doctors send you to the pathology firm to have blood tests, and it costs nothing.

 

You can certainly get a specialist wholly (or nearly so) on Medicare, the thing is that it's up to your GP to refer you to a clinic or specialist which is covered. Often they simply assume there will be too long a wait for the public system, so they don't even consider it. The perception that there will be a long wait isn't always true.

 

I can give you two examples: I just assumed I had to pay for an asthma specialist until someone told me about the Asthma Clinic at Royal Prince Alfred (which happens to be one of the best in the world). And when I had my throat problem, my GP referred me to a specialist who was very expensive (and useless), and I subsequently got a second opinion from a Medicare specialist (who cured me!). In both cases, I was seen within about six weeks.

Edited by Marisawright

Scot by birth, emigrated 1985 | Aussie husband applied UK spouse visa Jan 2015, granted March 2015, moved to UK May 2015 | Returned to Oz June 2016

"The stranger who comes home does not make himself at home but makes home itself strange." -- Rainer Maria Rilke

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You can certainly get a specialist wholly (or nearly so) on Medicare, the thing is that it's up to your GP to refer you to a clinic or specialist which is covered. Often they don't know.

This is exactly it. You end up floundering in a system that the doctors don't know or understand; and it is impossible for you, as a patient, to know or understand it. Yet whenever you try to complain, you just get told that it is your responsibility as a patient to inform yourself. The Australian health system is a source of so much frustration and my experience is that you get shockingly bad treatment whilst dropping money at every turn.


Feb 2010 Prospective Marriage Visa | Nov 2010 Temporary Partner Visa | Nov 2012 Permanent Partner Visa | Jan 2015 Australian Citizenship

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When you go to a GP you have two choices. Go public or private, just ask the GP to refer you to the one you want.

 

1) Public

----------

If you go public you will see a public specialist free of charge in the outpatient dept of a public hospital just like the NHS. Wait times will vary like the NHS. If you are admitted to hospital it will be free just like the NHS.

 

2) Private

-----------

If you go private you will see a private specialist in their rooms presumably just like in the UK. Medicare also subsidises private specialist appointments but there will be a significant gap. The first appointment has a larger gap than subsequent appointments. Private hospital insurance has nothing to do with specialists appointments.

 

If you are admitted to a private hospital your private hospital insurance will usually cover the stay. The private doctor will either:

- charge you a gap between what your private hospital insurance covers, what medicare covers (yes it chips in for private hospital doctors as well) and the total cost.

- charge you no gap as they have agreed to charge you as a "no gap" patient. You should ask.

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If you are admitted to a private hospital your private hospital insurance will usually cover the stay. The private doctor will either:

- charge you a gap between what your private hospital insurance covers, what medicare covers (yes it chips in for private hospital doctors as well) and the total cost.

- charge you no gap as they have agreed to charge you as a "no gap" patient. You should ask.

You are liable to get all sorts of hidden charges - gap for your own consultant; fee for the anaesthetist; excess fee for your insurance company; any medicines, devices or appliances used; potential charges for accommodation and nursing; extra charges if complications occur. You will not be able to know these charges before you are admitted.


Feb 2010 Prospective Marriage Visa | Nov 2010 Temporary Partner Visa | Nov 2012 Permanent Partner Visa | Jan 2015 Australian Citizenship

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You are liable to get all sorts of hidden charges - gap for your own consultant; fee for the anaesthetist; excess fee for your insurance company; any medicines, devices or appliances used; potential charges for accommodation and nursing; extra charges if complications occur. You will not be able to know these charges before you are admitted.

 

Yes I think this is always possible when you decide to use private specialists in private hospitals. The govt ombudsman encourages us to get a quote from the specialists before proceeding.

 

Personally, when we have been accepted as "no gap" patients the anaesthetist has also charged no gap or a small fee like $100 though it pays to ask this before hand. Hospital accommodation has always been fully covered accept for the agreed private hospital excess we signed up for.

 

This govt health insurance ombudsman page provides a summary: http://www.phio.org.au/facts-and-advice/informed-financial-consent.aspx

 

Here's some of the advice from that link:

 

Are you going to hospital as a private patient?

Before you receive your treatment you are entitled to ask your doctor, your health fund, and your hospital about any extra money you may have to pay out of your own pocket, commonly known as a ‘gap’ payment. Knowing how much your treatment will cost is called Informed Financial Consent.

 

 

  • Ask your treating doctor or specialist wherever practical how much their fee will be, and if you will need to pay a gap. For major treatment this information should preferably be provided in writing.

 

You may have more than one doctor involved in your treatment, for example, a surgeon and anaesthetist. Your surgeon should be able to advise who else will be treating you and how you can contact the other doctors to seek fee information from them.

You may have lower or no out-of-pocket medical costs if your treating doctors elect to use your health fund’s gap scheme. You are entitled to ask your doctors if they will use your fund’s gap scheme.

 

 

  • Ask your health fund whether your policy will cover the procedure, and whether you will need to pay an excess, co-payment or any other charge associated with the treatment. Your health fund may need you to obtain the Medicare item numbers your doctor will be using to give you an accurate quote. If you are within waiting periods, you will also need to ask your doctors to fill in medical certificates for assessment by the fund of whether benefits will be paid.

  • Ask the hospital whether they have an agreement with your private health fund and whether you will have to pay any gaps or extra costs. Your hospital should perform a membership eligibility check with your health fund before you are admitted and seek your informed consent to incurring any out-of-pocket costs associated with your admission. This information should preferably be provided in writing.

 

What can I do if my bill is much higher than I expected?

We suggest you first check whether you agreed to these charges before treatment, and contact your doctor’s office to discuss the reasons for the various charges.

 

The Private Health Insurance Ombudsman produces a brochure about medical fees, which is available on our website.

Edited by fish.01

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There is no doctor in the land (or none I have yet discovered) who will tell you all the extras because he or she will not know it You will be given a form to sign that sets out your consultant's fee and says all the others are unknown and that is your "informed" financial consent. Take it or leave it. You can argue with the ombudsman - that will just delay your treatment for up to a year as whilst the ombudsman first puts obstacles on your way before finally accepting your complaint and taking months to conclude that the doctors have done no wrong. I speak from experience.


Feb 2010 Prospective Marriage Visa | Nov 2010 Temporary Partner Visa | Nov 2012 Permanent Partner Visa | Jan 2015 Australian Citizenship

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There is no doctor in the land (or none I have yet discovered) who will tell you all the extras because he or she will not know it You will be given a form to sign that sets out your consultant's fee and says all the others are unknown and that is your "informed" financial consent. Take it or leave it. You can argue with the ombudsman - that will just delay your treatment for up to a year as whilst the ombudsman first puts obstacles on your way before finally accepting your complaint and taking months to conclude that the doctors have done no wrong. I speak from experience.

 

Yes I'm sure there could be unknowables, specially if the doctor is dodgy or the agreed procedure has to change in-flight. I think it is best to at least try and get in writing:

- What gap the main specialist is charging (if any) for the quoted medical procedures they are performing (using medicare item numbers)....ensure medicare and your insurer covers these medical procedures.

- Whether there are any pre-agreed appliances, medicines etc and how they will be paid.

- What gap the any other specialists involved will charge.

- Ask the hospital/insurer if there are any gaps for hospital accommodation + whether any other things may be charged as extras.

 

While many services will go as planned no doubt things can go badly in private insurance charging. Our family has had a fair few and all have been as expected or cheaper but not everyone is as lucky.

Edited by fish.01

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