My parents have always had private health insurance. Always. When I was younger, if you were a full-time student, you were covered under your parents’ private health insurance until you were 25. I was still a full-time student at 25, so I was covered by their plan until then. The day of my 25th birthday, my then-fiancĂ©/now-husband transferred his single-person private health to a couple one, and I joined his. I’ve never not had private health insurance. Not even for a day.
Our private health insurance currently costs our family of
five $560 a month. My husband’s company
pays just over half of this as part of his salary package, so our cost for our
insurance is about $250 a month. It’s
pretty good insurance, covering most things.
The only exceptions to our insurance level is joint replacements and
dialysis. Neither of these are covered.
Private health insurance in Australia also does not cover
the cost of a visit to your doctor (general practitioner or specialist) or the
cost of any medications. Medical visits
are covered by Medicare, which is available to all Australian citizens and
residents, and the cost of some medications is subsidised or reduced (also by
the government), particularly for those on lower incomes. Medicare may not cover the full cost of your
doctor’s bill, but clinics will advertise if they are “bulk bill” (they only
charge the standard Medicare fee per visit) or if they are not. My local doctor, for example, charges approximately
double the standard Medicare fee. You
pay the cost for the doctor’s visit, and then they process the Medicare rebate
electronically. The rebate money is in
your bank account immediately. The
difference between these amounts is referred to as “the gap”.
Private health insurance does cover the cost of dental
visits (regular check-ups and orthodontic work), glasses (although the actual
eye-test is covered by Medicare), private hospital care and a variety of
“complementary” therapies (think physiotherapy, massage therapy, chiropractor),
although the type of therapy and cost covered depends on your plan. Similar to Medicare, private health has a
fixed cost for each service covered, and if you chose a place that charges more
than that, you have to pay the difference.
Payment is made directly to the service provider – they will process
your private health rebate electronically, and then you pay any difference
owing. Most health care funds will also
give you a list of providers who charge the “standard” fee, so you can choose
someone whose rates are fully covered.
I had three babies as a private patient. My regular obstetrician’s appointments were
subsidised by Medicare, with me paying the gap.
My obstetrician’s office provided a list of all costs upfront (including
regular obstetrics visits, pregnancy ultrasounds, any extra blood tests), so I
knew what I would need to pay, and what Medicare/private health would
cover. My private health cover has a
$500 excess for obstetrics, which meant that I had to pay the private hospital
$500 up front. All other costs were
charged directly to my health fund. All
of my children were born at the same hospital and I had a private room with each. I stayed for six nights with the first, three
nights with the second and four nights with the third. Although four nights was the standard stay,
they let me stay six with the first because she was in the Special Care nursery
for the first four nights. Both my
obstetrician and her paediatrician wouldn’t discharge me without her. For each of those three stays, I paid
$500. My health insurance paid the rest.
I’ve never had a disagreement with my health insurer over
payment of a bill. The closest it came
to this was after my eldest daughter was born.
Because she was born not breathing, they did a number of tests (swabs
and blood tests) to determine if she had an infection. Over the course of the six days we were in
hospital, they did about a dozen such tests.
The first two tests were done in the first minutes of her life. She wasn’t actually registered as a patient
at the hospital until after they’d intubated her and got her breathing (a
course of action that I fully support), and these two first tests were
therefore technically performed on an “out-patient”. Consequently, they had a different code on them
to the others, and the insurance didn’t cover these particular tests on an
out-patient. When I went in to get my
rebates processed at my fund’s office, the woman helping me explained this. I explained why she’d technically not been a
patient at the time. The woman gave me
the details of what I’d need to get the tests recognised and covered (several
forms signed by at least two of the doctors, information from the hospital),
which sounded like a lot of effort to me.
I asked how much the rebate was worth.
She looked it up and told me $15.
I told her not to worry about it.
Let me please point out that I’d have gotten the same level
of care if I’d been a patient in a public hospital, not in a private one. The difference would have been in the room
type (possibly a shared room) and in the length of stay (usually 24 – 48 hours
for a regular birth, with a midwife coming to your home to check on you and the
baby for a couple of days later). I’d
also have been allowed to stay longer in the public system with a baby in
special care, just as I was in a private hospital.
To point to the strength of the Australian medical system,
particularly in big cities – I’ve only ever had to call for an ambulance
twice. Both times were last year. The first was for my son – he slipped and
fell off the bed and hit his head. The
ambulance was there within ten minutes.
The paramedics did a full range of checks, even though he was very
clearly all right by the time they arrived.
They offered to take us to the children’s hospital for observation and
reminded me to call immediately if anything changed. There was no charge at all for this.
The second ambulance was for me. I had extreme dizziness, to the point where I
couldn’t stand up. Again, the ambulance
was at my door within ten minutes. The
paramedics did all the standard checks, plus two separate ECGs in my living
room. They took me to a public hospital (they
offered me a choice of three; I chose the closest) and I had to provide my
Medicare details. No one asked a thing
about private health insurance. I was in
the waiting room for about three hours, during which time a nurse came round to
do observations (blood pressure, temperature, etc) on everyone waiting
there. I saw a junior doctor (who did
all the same things as the paramedics, plus another ECG and a pregnancy test). The consultant (senior doctor) then came in
and ran through all the same stuff (minus the ECG, although she did study the
results of both the paramedics’ and the junior doctor’s ones). By the time all this was done, I was feeling
fine, and there was no obvious cause for my dizziness. The consultant recommended I see my GP to
have some bloodwork done.
Total cost of my trip to hospital and all of that? Zero.
The only thing I paid for was the taxi ride home. I could have paid less (there is excellent
public transport between the hospital and the suburb where I live), but given
my prior dizziness, I figured a taxi was a better choice.
We’re lucky to live in a place like we do, with accessible and affordable health care, with or without private health insurance. Yes, we pay taxes to cover this privilege, but it’s something I’m perfectly willing to cover. There are a lot of places in the world where health care isn’t as easy to get to or to afford.
