Confused about Health Insurance......HELP!!

[Floweryfields]

I have had MBF basic hospital cover since I paid a fortune to have my lap in 09. So I've been getting some pain again each month and am beginning to think I will have to go back again...*sigh*. Anyway....I got out the receipts and rang MBF because I'd like to know what I am covered for.....
WELL, it seems like not a whole lot!!! I have a $500 excess, which I knew but the woman tells me that I am covered for the scheduled fee amount issued by medicare only - so that means all they will have to pay is the 25% difference - so in hospital medicare pay 75% of the scheduled fee - so MBF will pay only the 25% difference which is only a small amount really.
As all doctors charge well above the scheduled fee, I worked out (based on the old receipts), that I will still be out of pocked by about $2500.
Does this seem right to anyone? I found it totally confusing.

HELLLLLPPPP!!!

PS Scared I have put this in the wrong spot and will have it locked - but I can't find anything about PHI.

[onthefly]

Your clinic/doctor should be able to tell you how much out of pocket you'll be

[Floweryfields]

One other thing - she said nothing would be covered if medicare doesn't cover it - I said well nothing done in private hospital is covered by medicare - (that's right isn't it? Medicare didn't pay a cent of my hospital bill last time) - she said well they don't cover it then....what?? Why do I have hospital insurance then?

[onthefly]

Maybe she means if the procedure doesn't have a 'number' thingy for assigned benefits under the medicare scheme...?
Sounds like maybe you need to call the hospital or your doctor.