Health insurance - to have or not to have???

[*EJ*]

Miss E that is really helpful thank you!!

I was just talking to my cousin the other day about the LI & IP coming out of super but wasn't certain how it all worked, we will discuss it next week. Our IP, LI and DH's super are all with the same company. Definatley an option.

And it's also great to know that we aren't tied to a certain company like you said. I've learnt so much in the last few days.

[sepata]

Can I add to the original question? I have never ever had PHI and neither had hubby, nor did our parents when we were kids. I know that not having it means you get put in waiting lists when you need something, but generally everything is covered by medicare? But when you have PHI you may get treatment straight away but you have to pay for loads of things like blood tests, ultrasounds etc. Is that right? And if so, is the only benefit to PHI not going on waiting lists?

[Trillian]

Can I add to the original question? I have never ever had PHI and neither had hubby, nor did our parents when we were kids. I know that not having it means you get put in waiting lists when you need something, but generally everything is covered by medicare? But when you have PHI you may get treatment straight away but you have to pay for loads of things like blood tests, ultrasounds etc. Is that right? And if so, is the only benefit to PHI not going on waiting lists?

No, it's not the only benefit. But you do have to weigh it up for your own circumstances. As I said in my first post, before we had kids we couldn't see the point in it, but now we have them we wouldn't be without PHI. Even if you have PHI, you are still able to get medicare for anything you get treatment for. Bulk billing for bloodtests are still under medicare even if you have PHI (unless if they are ordered by a specialist Dr and in which case EVERYONE would have to pay for them because they are not bulk billed anymore), same goes for ultrasounds - if your PHI doesn't cover it then you are still covered by medicare to make a claim just like someone who doesn't have PHI would be able to do. But if you have an ultrasound or bloodtest in hospital and you are covered for it under your PHI, then you wont pay for it. I see health as a consumer industry just like any other - if I walk into a cafe I'm paying for the food I get so I expect to be able to choose what I want to eat. Just like with PHI - I'm paying for it so I pay for the luxury of being able to choose a Dr. If I was getting food for free, then I would expect to just get what I'm given and this applies in hospitals too. Even if you are able to access great Drs in a public setting, that really is the luck of the draw.

ETA - Taurean, DH's PHI was originally with HBF, but they are virtually non-existent in the eastern states and trying to make a claim for anything was like pulling hens teeth. Not only that, you had to make sure that the person who treated you was actually registered with them as a provider and if they weren't you had to get them to fill in a provider form just so you could make a claim. It was total bull**** so the company changed to GUHealth. Unless they have seriously changed their game in the last 4 years then they aren't worth it to anyone outside WA.

[Jennifer13]

Can I add to the original question? I have never ever had PHI and neither had hubby, nor did our parents when we were kids. I know that not having it means you get put in waiting lists when you need something, but generally everything is covered by medicare? But when you have PHI you may get treatment straight away but you have to pay for loads of things like blood tests, ultrasounds etc. Is that right? And if so, is the only benefit to PHI not going on waiting lists?

There are many medications and health services that are not covered under Medicare (or they may be, but they are in such short supply that it's not only the waiting list but being able to access those services that is the issue). Dentists are one example, yes, there are public dentists (mostly through hospitals) but good luck getting an appointment for an annual check up!

Physios, chiros, most other 'alternative' therapies are not covered by Medicare. You can go to a dr or pharmacy and get drugs if you are in pain, but ongoing pain management through anything I mentioned you'd have to pay out of pocket without PHI. Also, a lot of health aids might not be covered (or if they are you are very restricted in what you can get, glasses come to mind here, as do braces). My orthodontic expenses all up cost over $12,000 (braces, dental work, oral surgery, implant). I got about two thirds of that back from PHI. The point is not just that I would have been more out of pocket, but in all likelihood, because it was 'cosmetic' (let's ignore the fact I was grinding my teeth down to nothing, had one missing completely and would have needed significant work and probably dentures in future when it got acute) it would not have happened at all in the public system.

Psychologists and psychiatrists are another one - there are some that are publicly funded, but unless you have an acute condition and can get to where they are based, then you certainly won't get treatment in the timeframe you might like.

That's just off the top of my head. So if it's a specialist that you can find in a public hospital, yes, Medicare will cover that and technically you would be more 'out of pocket' if you went to someone privately. But because there are so few, you might not be able to get all the treatments you would like.

I actually have used the public hospitals when I needed to (not as an in-patient) and for acute issues, like an injury, I found them to be good. But when I had a sore back this week, I was very grateful to be able to book in to see a chiro immediately and only pay a very small fee by comparison to what the actual fee was, thanks to PHI. And with two more visits needed this month, then my PHI has paid for itself for the month. And that's before I factor in the physio-led antenatal aqua classes I take every week that PHI also contributes the majority of the cost towards.

At heart, I'm actually more of a socialist and I have a strong belief that publicly funding PHI (though the PHI rebate) is not the best use of public health money and taxes. I would like all people to have access to the health services I mentioned above, without preference going to those who can afford it and not those who need it most. But that's a debate for another day! I work with the system I find myself in.

[Taurean]

Just wanted to give some recent ambo 'costs'.

My parents have been on my brother's case since his late teens (he's almost 29) to get ambulance cover. He is a mad keen bmx rider and has broken so many bones over the years and has so many trips to hospital that we've lost count. They assumed he'd sorted it out until last week when he told them he has an outstanding ambulance bill after an accident at a skate park in Melbourne earlier this year. It's for $2500 for a quick trip from the skate park to the closest hospital. He was unconscious and bleeding from the head badly so his mates didn't even think twice before calling 000, an ambo was necessary. It turned out to be one hell of an expensive joy ride at the skate park that night though.

Food for thought.