I DON'T Feel Better Now Thank You Medibank Private!

3 Feb 2012: Once again, my own life has led to a blog…. As some of my regular readers may remember, last year I began walking on some Canadian crutches, to build up the strength in my legs, however, after just a few short months of doing so, and loving it, I felt a kind of crackle in my ankle, which was followed by a lot of pain, and limited movement in my ankle.

After many different doctor appointments, tests, specialist and hospital visits, where I was told that there was nothing wrong with my ankle and was advised to ‘just rest it'(although I wasn't aware of occasionally walking on it and transferring to and from my wheelchair constituted as anything else), I was finally given the diagnosis that I had a piece of bone in my ankle, that was floating around, that had been there for possibly ten years or more, which had now decided to lodge itself into my ankle joint, causing pain, and restricted mobility.

I was advised that I would require an ankle arthroscopy, to remove the irritating piece of bone that has been bothering me. So last year, I found myself a surgeon who had been recommended to me, by a fellow OI (brittle bones) patient of his. I saw the specialist last November, and he sent me for more tests, to confirm what I had already been told (that there was loose bone in my ankle joint), and at the follow up appointment, I would find out when surgery could be done. However, the earliest available appointment wasn't for three months! Although far away, I thought I'd waited this long, what's another three months?

Yesterday was my follow up appointment. I organised to leave work at 1:30pm (three hours earlier than normal), for my appointment at 2:45pm. I arrived a little bit early, just to give myself time, and allow for traffic etc., only to be told that the doctor was running 45 minutes late, which I usually expect at doctor's offices anyway. Except, I wasn't seen until more than TWO HOURS LATER!!! I was so mad, but being something that I need sorted, I was at the mercy of the doctor's surgery, and kept my boiling disposition to myself.

I was given all of my forms and important information for the surgery that was scheduled for March, when I was advised of the amount of money that I would have to fork out to cover the specialist's surgery fees. It was at this point that I thought to myself, why in the world, do I bother paying for private health insurance?!!

I pay around $60 per month for the lowest type of hospital cover, which doesn't sound too bad, but when you add that up, for every month, for the past six years, it works out to be $4,320! And I've NEVER needed to use it, EVER! But anyway, one would assume that when health insurance is taken out, the hospital fees etc. would be covered by private insurance. I was under the impression, that if I required surgery ever, I would pay my excess, which is a one off payment of $250 for a whole year, then, I would be covered for all the other fees charged, but NO, that is not the case at all!

I called my health insurer up yesterday to find out what it is, exactly, that they would be contributing towards my scheduled surgery. I discovered, to my disgust, that they are covering $150 towards the operation, Medicare pays $350, and I am left with $970 for the specialists fees, $250 excess, plus an unknown amount for the cost of the anaesthetist, which will not be disclosed, until after the operation is over.

I thought this may have just been an exception because I am on the lowest level of hospital cover, but after a discussion with my friends, some of who also have OI, I was advised that this is quite a common occurrence in the health care system. And we were all left to wonder, why we bother taking out costly insurance, when the cost outweighs the benefits.

The simplest way that it was explained to me, is that a private doctor can charge whatever they feel like for surgery, this fee is called the ‘gap', which is not covered by health insurance. Some anaesthetists charge their own fees, and some can be covered under insurance, but if they aren't, you are left with their fees as well.

So for me, for surgery on something that quite honestly isn't ‘life altering', I will be out of pocket by almost $2000, which I would quite frankly, rather put towards saving for a house. My health insurer suggested that I can request weather or not the doctor would be willing to contribute to the gap, which I have now done, and am waiting on a response. But if he refuses, or doesn't contribute a reasonable amount, I will be asking to go onto a public waiting list, to have my surgery done in a public hospital, whenever I can be fit in.

I'm not sure if I'm being naïve, but I always thought, covering my butt with private health insurance would pay off in the end. But, honestly, if I ended up in hospital with an emergency, because of my disability, and the complications that could arise from it, I wouldn't be handed over to an intern to look after me, my case would be given to a doctor who has experience in dealing with OI, so basically, private health insurance for me is a waste of money, and I want out!

After this debacle is over and done with, I will be cancelling my insurance, and going through the public system from now on, which by the way, I hear is much better in Australia than some countries, so it really isn't that bad at all compared to some.