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Is private health insurance really worth it?
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#1 Myprincesses

Posted 16 January 2013 - 11:10 PM

I am really begiining to wonder if the $260 a month is really worth it for private health insurance. Today we put in a claim for a lecky easy seat for DD1 (has JHS) under the medical appliances clause. I get an email back declining it as it wasn't on the list of their approved medical appliances. Mind you there isn't a list anywhere is our documents or on the Internet specifying what is on the list. All it says is any medical appliance prescribeby an OT, PT, SP or medical practitioner (according to them it includes wheelchairs, walkers, toilet seats, fusion raisers, showers tools).

I have appealed the decision and escalated the claim to the claims manager along with all the supporting documents to say who prescribed it. Just waiting to hear back.

But it really got me thinking are we just wasting our money with private health insurance. Yes it was great whilst having children, but we are certainly finished and cannot have anymore so don't need obstetrics. We have recently moved and the private hospital here doesn't have a good rep and the public hospital is great. Private hospital also doesn't see kids under twelve. All private doctors treat at the public hospital. There are no private OT, and PT services for DD so will be using the public system anyway, and possibly for speech as well.

Medical appliances is limited to $1000 every three years and by the sounds of it has a very limited selection of appliances they will fund.

I have looked around and there really isn't much different with other funds.

Is it really wrth us forking out $3000 dollars a year when they won't let's claim the things we really need to. Iwould rather invest the money in a high interest saving accountant draw on it if and when we need to. We don't earn enough to be penalize.

It is justo frustrating.

#2 sad small umbrella

Posted 17 January 2013 - 09:14 AM

We don't have PHI either.  It made no financial sense for us.  Once we hit the safety net, we are paying very little.  We're better off putting the money saved aside and using it when needed.

#3 HoneyMurcott

Posted 17 January 2013 - 09:43 AM

We have good hospital cover but no 'extras'. This saves us a very considerable amount but leaves us with the option of private hospital treatment which has come in handy for tonsils & sleep studies for the children & I'll use it for vascular surgery soon. We have a separate savings account for the 'extras' such as optical & dental. Physio is public (hurray!) & we just manage the OT & speech as required - which over the years has been way more than any health fund would have covered.

#4 Always amazed!

Posted 17 January 2013 - 11:03 AM

We have private health but havnt used it once for our sons needs.

We are going to cut all extras and keep hospital cover only.

#5 Cat©

Posted 17 January 2013 - 12:56 PM

We had PHI for many years and the main things we have used it for in the past is dental - the boys get to go to a private dental paed (due to the EDS) and we dont ahve to put up with the pathetic public system for dental (it is here for kids anyway!).

I worked our out and this is why I kept it -
Our PHI with GMHBA is (recent increase) $240 a month, so $2880 P.a.
Dental is $1500 a year minimum for checkup and clean for 5 boys.

When we also use it for speech and OT for one, Physio and podiatry for all, we claim back usually another $1k (we went minimally as we couldnt afford it) - this year it will be more as many of them have started speech and OT, and psych and we can afford more sessions.

So as you can see we claimed back last year over$2500, our PHI cost $2880, so for us its really costing us almost nothing but we have the extra reassurance of private hospital if we need it plus the other benefits should be use them.

This year I would say our claims will easily hit $4k at least with 5 of them accessing services - plus two need braces, plus I need dental work as well, all necessary evils!!

So perhaps work it out realistically as to what you use now and what you would use when services run out (some EI services can stop when kids start YR 1) and then go from there. I would love to kick ours but when I worked it out it wasnt really worth it unless we went back to GOV dental for the kids (ick) and I stopped taking them to therapies (gov therapies suck here, there is almost none!)

#6 IsolaBella

Posted 17 January 2013 - 01:33 PM

We are thinking of dropping our extras. Also thinking of dropping obstetrics as we aren't planning on any more kids.

Don't forget you may have to pay extra Medicare levy if you drop the hospital part.

Our PHI only pays $200 pa towards speech.... Helpful when our speech costs have been $4k for the past year (not).



#7 Cat©

Posted 17 January 2013 - 04:20 PM

PPhave you checked out GHMBA? ours pay $800 total PA family for OT but $500 per member for speech. Then Physio and other stuff is also extra to that. Its  not a heap more but might be worth the change if the annual costs are simialr.

We have top hospy and top ancilliary and pay the $120 a f/nt with a $500 excess ($1000 per yr per family) but we have only used hosptial once and paid the $500, so wasnt worried about the excess.



#8 IsolaBella

Posted 17 January 2013 - 04:28 PM

May be worth a change.



#9 mez70

Posted 17 January 2013 - 04:36 PM

We used to have both Hosp and extras but now currently only have hospital,
When we had extras we were claiming more than the extras actually cost as DH and I both have glasses, DD was on weekly ST and then there was dental and Chiropractic.

We will NEVER not have hosp for many reasons but I will never EVER be reliant on the public sector for my families health as what they see as uregnt and a reasonable time frame and what I consider to be the same is miles apart. I know one of my DD's specialists who we see privately will not see "self Funded" private patients due to the nature of the specialitiy and the fact that if my DD need surgery done privately I would be looking at TEN's of thousands of dollars due to the nature of said surgery and length of hosp stay needed.

I have great public facilities which I do use but when my older DS saw a Gastro and needed some diagnostic scopes he could have been done 2 days later (but was first day of school) so we took the very next 1 which was 5 days later, in the morning etc all privately, he would have been waiting a while on public list.

I dropped our extras once DD stopped her speech and OT as we were not claiming enough , also we had similar coverage for aids and appliances whic was 1 every 3 years to the value of $1000.0  However by dropping our extras we then applied to have the Brace funded under the states aids and Equip program . This has meant her brace can be replaced when needed and in the space of 2.5 years she has had 2 Boston Braces at $1600.00 each, plus all the maintainance and adjustments etc for the total out of pocket to us of $100.00.....

I like knowing that IF DH or I need hosp we can take advantage of the private system and having worked for a major health insurer and processing the claims for Hosp stays I would NEVER self fund as I have seen how something simple can cost thousands just for the hosp portion

#10 handsfull

Posted 17 January 2013 - 04:42 PM

We wouldn''t drop our private cover.  Both DDs have glasses yearly, DH and I need reading glasses.  We periodically need physio due to sport injuries, both DDs need speech therapy (on hiatus at the moment).

DD2 had an operation in October which I would definitely would not have had done in the public system here.  Have experienced it once and that was enough to say never ever again!  

Both DDs need blood tests and due to their severe needle phobia up until 6 months ago had to have them in hospital under sedation ($950 each) which private cover paid for.

Our premium is $285 a month but include top hosp and top extras.  I feel we do get our money's worth not every year but at least every second one.

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#11 Myprincesses

Posted 17 January 2013 - 04:56 PM

I think I will look at GMHBA.

The thing is where we have moved to there are no private paed OT or PT and are just waiting for call back from community health. We are already into community health for speech (no waiting list here this year!!!! Yiippee) and it is a really strong speech program. So we won't be using it for therapy unless DH or myself need it and then our really close friend is a physio, I am an OT with hand therapy experience and a really close friend is also a hand therapist. I know they would be upset if we went anywhere else.

The private hospital is atrocious so would only go to the public hospital anyway.

The main thing we would be using it for is dental, medical appliances for equipment.... If I could pick to have just those extras covered it would be great!!! LOL

I need to do a bit of research I think. We will keep Atleast basic hospital as we are both over 30 and Atleast we would be a private pt in a public hospital.

#12 newphase

Posted 17 January 2013 - 06:30 PM

I think I have saved $20K plus by NOT having PHI, and payed for DD's tonsils out private which was $2700 all up...got it straight away without PHI!
Got wisdom tooth out in PH, cost $400 only.

Go over safety net for psych bills etc for DD after about $800+ out of pocket last couple yrs, pay minimal thereafter.

I think by NOT having PHI it has saved me $12+k at least!!

Just never seemed worth it to me!

And re dental, school aged kids are covered under school dental scheme, so like $30 a visit for a clean, scrape and a filling for DD! I use to go to a private dentist for all kids until I was told about this only last year damn it!

Edited by newphase, 17 January 2013 - 06:32 PM.


#13 FeralMinx

Posted 18 January 2013 - 11:57 PM

Another saying GMHBA is worth it, and justifies it similarly to PP, that the platinum extras claims almost entirely cover the top hospital costs (which is the cover I wouldn't ever drop).

#14 lishermide

Posted 19 January 2013 - 09:18 AM

I wouldn't be without it. We've used it many, many times.

Most recently DD13 had surgery that is classified as elective. Try telling a 13yo who's been on crutches for 8 months that it's elective!

She has been under the care of a highly regarded orthopaedic surgeon for the past year. Her particular case is quite difficult, and not at all the usual. Part of her surgery was investigative. There are other specialists involved - endocrinologist, hematologist. If we were to have had this surgery done publically two things would have happened:

a. she would still be waiting
b. the surgery would have been performed by another doctor.

Call me crazy, but I can't imagine sending a child in to have surgery with anybody but the doctor who knows her history, did her prior surgery, and has personally liaised with other specialists on her behalf.

No way would I leave the health of my family to the public system. It's expensive, I'm sure I could find more enjoyable ways to spend the funds, but it's not negotiable here.

#15 Feral Grey Mare

Posted 19 January 2013 - 03:28 PM

We dropped ours after our second child as we just could not afford it. DH is currently receiving treatment for lung cancer and all chemo, scans etc have cost us nothing. His sister is having similar treatment in a different public hospital and pays for part of every treatment because she has PHI. As both our children compete in dangerous sports (motorcross and showjumping) we have kept ambulance cover only. Over the years they have been treated in public hospitals for broken arm, collarbone and pelvis  and multiple stitches, bumps and bruises and have received first class treatment in the public system in a regional hospital.

#16 handsfull

Posted 19 January 2013 - 03:47 PM

QUOTE (lishermide @ 19/01/2013, 10:18 AM) <{POST_SNAPBACK}>
I wouldn't be without it. We've used it many, many times.

Most recently DD13 had surgery that is classified as elective. Try telling a 13yo who's been on crutches for 8 months that it's elective!

She has been under the care of a highly regarded orthopaedic surgeon for the past year. Her particular case is quite difficult, and not at all the usual. Part of her surgery was investigative. There are other specialists involved - endocrinologist, hematologist. If we were to have had this surgery done publically two things would have happened:

a. she would still be waiting
b. the surgery would have been performed by another doctor.

Call me crazy, but I can't imagine sending a child in to have surgery with anybody but the doctor who knows her history, did her prior surgery, and has personally liaised with other specialists on her behalf.

No way would I leave the health of my family to the public system. It's expensive, I'm sure I could find more enjoyable ways to spend the funds, but it's not negotiable here.


this....especially for us.  


#17 sad small umbrella

Posted 19 January 2013 - 08:27 PM

It really does depend on who you are seeing and what care you need though.  For us, it makes sense to save the premium as we would not use the insurance.  A lot of the testing we had is only done in the public system FREX.


#18 lishermide

Posted 19 January 2013 - 09:27 PM

Sure, if I knew we wouldn't need it I wouldn't pay for it either. But how would you know that?

I didn't foresee the issue we are having now with DD. Nor the time before that when DH fell off a roof. Or his motorbike accident requiring 3 surgeries. The fact they all happened makes me confident that I will continue to pay for PHI so I can access the best possible for my family.

It's too late to put it in place after the fact. I guess what's important to one family isn't to another though.

#19 sad small umbrella

Posted 19 January 2013 - 10:28 PM

Oh yes I am totally risking that my guys will need a conventional operation which PHI would be a most excellent option to have.

What I am talking about is having PHI solely for the special needs aspects.  We've been better off not spending the money on PHI for the last 13 years as none of the surgeries  have been done privately (and most of the more esoteric ones are not available privately).  I think we've paid out of pocket for a couple of MRIs and anaesthetics...

If you are buying it solely for the SN aspect, I'm not sure it makes sense.  If you are buying it because of your income bracket and because you think every family should have it, it makes sense.



#20 Cat©

Posted 19 January 2013 - 11:26 PM

I think it comes down to the special needs that you and your children have, if the services they need are readily available freely anywhere and also the area you live in then thats great but many services are booked up to the hilt, or not available for many many months unless you go private.

For *us* the boys needs are great, and most of those needs are "extras" so speech, podiatry, OT, psych, physio etc etc, and *if* they need hospital care then chances are that will be elective or at least not at the top of the list - liek now we are waiting for a slow transit study, it will be months.

I know my operations when needed will be months if not years, as I have watched far too many people with EDS related conditions suffer for months and years as they are unable to afford to go private for operations.

Dhs severe hammer toes were not even considered publicly (even though every step was absolute agony due to the severity of them), but he had then done privately within a few weeks of seeing the specialist, same with his colonoscopy, told 6 months on public, was done a week later privately. All things that relate to our "special needs". If we were healthy individuals with healthy children I honestly dont think we would keep PHI, but as we all have medical needs and the children have therapy needs taht cant be et via public then we will keep it for a life time.

#21 sueb31

Posted 19 January 2013 - 11:27 PM

As an adult with SN there are a number of things that you can't get publically. Dental exams under general, MRIs under general, endoscopes and colonoscopies being the major ones.

Elective orthopaedic operations would be the next most common.

For a child with SN it probably depends. You have a much greater chance of getting the treatment you need as a child rather than an adult. (I am commenting on hospital cover, not extras)

Sue

#22 sad small umbrella

Posted 19 January 2013 - 11:30 PM

But even then if a colonoscopy or endo is once every 2 years?  You're financially ahead if that is all you need.

#23 sad small umbrella

Posted 19 January 2013 - 11:35 PM

Oh and Cat?  The nuclear transit studies are only available on the public health system so having PHI is irrelevant.  

I've got no strong opinion if someone looks at their situation and it plays out differently.  I just found that we were better off having the cash to pay for testing or didn't need PHI for testing.  I know we play the hospitalistion roulette with that and so far are ahead.

#24 Cat©

Posted 19 January 2013 - 11:47 PM

Oh didnt know the NTS was only public, I know it is in WA, heck anything child related is at PMH lol no other choice, but thought there may have been other options in other parts of Oz.

As I said, its totally dependent on the circumstances of the child/children and the parents, and the special needs requirements.

A person with 1-2 children might find much less benefit than us with 5 requiring services, so again dependent on family circumstances totally.

#25 unique_gem

Posted 20 January 2013 - 07:58 AM

We have top hospital and top extras and every year we claim back more than we pay out so totally worth it for us .  We claim chiro to the max benefit, glasses for DH and DD#2 orthotics for DS and DD#2, dental is very expensive as we see a pead dentist plus anything else that happens during the year.  When DD#2 had neuro surgery we had no choice but to go private because there is only 1 surgeon in Australia she has spent time in ICU which would have sent us broke if we hadnt have had PHI and the surgery was needed immediately so we wouldnt have been able to get the PHI then do the surgery later.   It is Insurance you dont know when you will need it but for us it has definately been worth it over the last 8 yrs.




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