007 - Private health Funds being Ripped off by Hospitals - Daily Telegraph

Health fund members charged $2772 for public hospital care they can get for free on Medicare

HEALTH funds are charging families up to $2772 a year for health insurance that only covers them in a public hospital — something they get for free under Medicare.

SUE DUNLEVY and LISA CORNISH 

NATIONAL HEALTH REPORTER, 

HeraldSun
April 27, 2014 12:41am


HEALTH funds are charging families up to $2772 a year for health insurance that only covers them in a public hospital — something they get for free under Medicare.

And taxpayers are subsidising up to 40 per cent of the premiums on these products even though the tax subsidy was meant to shift people to the private sector to relieve pressure on public hospitals.

Worse still, when the families use their health insurance in a public hospital they could be up for an excess of up to $1,000 under some policies.

Health funds are charging families up to $2,772 a year for health insurance that only covers them in a public hospital — something they get for free under Medicare.

And taxpayers are subsidising up to 40 per cent of the premiums on these products even though the tax subsidy was meant to shift people to the private sector to relieve pressure on public hospitals.

TELL US: Do you think paying for hospital cover is worth it?
Worse still when the families use their health insurance in a public hospital they could be up for an excess of up to $1,000 under some policies.

Data from the federal government’s private health insurance comparison website reveals there are now 15 health insurance policies for families in South Australia offering public services.

Prices start from $147.95 per month for GMHBA’s Frank Basic Hospital offering, which requires patients to pay an excess of $500 per public hospital admission and wait between 2 and 12 months for treatment.

The most expensive offering, HIF’s Basic Hospital package, also requires customers to wait but with no excess. And it is a mere $231.65 per month.

These policies don’t give health fund members any advantage in jumping public hospital waiting lists, or getting access to a single room.

SA Health says “prioritisation of treatment for any patient, whether public or private, is made on the basis of clinical need”.

The only extra private insurance offers is choice of doctor but even then that is restricted to the doctors who have the right to work at that public hospital.

Health fund NIB says its public hospital only product range is aimed at higher income earners trying to avoid the tax penalty that applies if they don’t have health cover.

“Customers should be aware that public hospital only products provide a very basic level of hospital only cover, such as the choice of a doctor or medical specialist in a public hospital,” an NIB spokesman said.

Health fund BUPA said its family public hospital cover did have a provision to pay for private hospital care for children in its Members First or Network hospitals for when adults were involved in an accident.

Otherwise adults were only covered for public hospital care.

It was attractive to people who lived in regions where there were no private hospitals because it allowed them to choose a doctor who worked at their public hospital, the spokeswoman said.

Private Health Insurance Administration Council chief Sean Gath says public hospitals are keen to get privately insured patients because they earn extra money from health funds when they do.

Hospitals get paid around $326 a day by health funds for treating an insured patient in a shared ward and $561 if they use a private room.

The number of privately insured admissions in public hospitals increased from 14 per cent to 17 per cent between 2010 and 2013 however some of these people would have policies that also covered them in a private hospital.

Between 2012 and 2013, private hospitals saw a drop of more than 1.5 million in the number of episodes for the year.

Australian Private Hospitals Association chief Michael Roff questioned why the government was providing a 30-40 per cent tax subsidy for these public hospital products.

“It’s hard to see how the rebate meets the policy objective and I question whether it should be subsidised,” he said.

“Why would anyone buy a product to go to a public hospital which they can go to for free?” he asked.

Consumers Health Forum Australia chief Adam Stankevicius said one reason people may be wanting to use public hospitals was to avoid gap fees.

“When the Coalition Government introduced the health insurance rebate 15 years ago to encourage people to take health insurance, it argued that having more Australians with insurance would take the strain off public hospitals. But the reverse has happened. While health fund numbers have risen dramatically, waiting times for elective surgery continue to lengthen and there are compelling incentives for insured patients to get public hospital treatment,” he said.

Originally published as Health fund public hospital ‘rip-off’

Free public hospital care is our fundamental right

Sue Dunlevy

August 7, 2019 7:04pm

Subscriber only

Public hospitals are underfunded but bullying seriously ill cancer patients and desperate mothers of sick toddlers to get their health funds to pay for their treatment to solve the problem has got to stop.

Free public hospital care is a fundamental right for all Australians, it’s what makes our health system the envy of many countries but health fund members are being tricked into thinking they have to pay.

RELATED: Health fund’s warning: Don’t ditch your insurance

In the last year I was twice a witness to the extreme pressure public hospitals employ to get people to use their private health funds to pay for care they are entitled to for free.

My young nephew who was undergoing gruelling treatment for cancer had fallen ill with an infection and had to be hospitalised.

We all have the right to free public hospital care without the pressure of out of pocket costs. Picture: istock

Before he had even settled into his public hospital bed a staff member appeared to pressure my sister into using her health cover.

When she said no and explained she wasn’t working while she cared for her sick son and could not risk any out of pocket expenses the staff member kept pressuring her.

She was made to feel she was letting the hospital down by refusing and when I backed her up and said she was entitled to free care the bossy staff member told her he would “have to report you to my manager”.

Earlier this year, a highly stressed colleague who went to a public hospital emergency department with terribly sick toddlers was asked to use her health cover to pay for their treatment.

She called me and asked what she should do.

MORE FROM SUE DUNLEVY: Health shake-up won’t solve doctor greed

“Ask them if you will get any benefit from using your cover like a private room and the doctor of your choice,” I said.

The answer to both those questions was no and she refused.

These pressure tactics are being used on people whilst they are in the midst of a health crisis, when they can’t think clearly and in some cases may not even properly understand their right to free care in a public hospital — and it’s not fair.

Private health insurers say public hospitals now employ staff whose full time job is to approach health fund members and get them to bill their cover for public care.

And they says its reached perverse levels in South Australia where the state is contracting 13 private hospitals to treat public patients while giving privately insured patients priority in public hospitals.

Pressure tactics are being used on people whilst they are in the midst of a health crisis — and it’s not fair. Picture: istock

The number of patients cajoled into using their cover in public hospitals is rising by seven per cent a year and its now costing health funds over $1.6 billion a year.

What the hospitals don’t tell you is that when you elect to bill your health fund for care you are entitled to for free, it’s pushing up your health fund premiums.

Insurers calculate premiums would fall by $100 a year for families if public hospital care was not billed to health funds.

Worse still many patients end up being charged gap fees of up to $1,500 when they use their health fund in a public hospital, if they’d stayed as public patients their care would have been free.

RELATED: Health fund reforms add to pressure on public hospitals

But health funds are not blameless in this game, while they don’t want their members to use their cover in public hospitals many of them offer products that only cover people in a public hospital.

The Australian Health and Hospitals Association rightly asks why funds are selling these products when they don’t want to pay when their members use them.

These products are a con and pure junk, they cover you for something you are entitled to for free under Medicare and should not be allowed to attract a government subsidy.

Former health minster Susan Ley pledged to scrap them as part of recent health fund reforms but the industry successfully fought the measure claiming it would add 16 per cent a year to health fund premiums.

The number of patients cajoled into using their cover in public hospitals is rising. Picture: istock

If health funds want to be taken seriously about public hospital charges they need to get rid of these junk policies.

There is a serious underfunding of the nation’s public hospitals as the population ages.

The AMA’s report card shows waiting times for elective surgery are at the highest level ever recorded.

Elective surgery admissions per 1,000 population actually went backwards by 1.5 per cent nationally.

Only 64 per cent of urgent patients are being seen within the recommended 30-minute time frame in emergency departments.

Public hospitals are just that, they are meant to be funded by our public tax system, it’s time state and federal government fixed the problem.

Sue Dunlevy is News Corp’s national health correspondent.

Originally published as Free public hospital care is our fundamental right

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

IMHO....

Migrated to Australia in 1976 as a PG Student, met my future wife and got married in 1980 and we had Private Health Cover with Medibank initially. We did some home work and consulted friends etc and decided to switch to HCF's Top Cover on 5th June 1992. Membership Number 17301254. As retirees we still maintaing this Top Cover costing us Aud $450 per month even though we have zero income. Our Hospital and Extras Cover includes Top Advanced Hospital Gold Nil Excess and Multi Cover.

When we joined HCF we were young and healthy and this Cover may not have been warranted. On Hindsight now in 2019 I believe this is one of the best decisions we have made and glad we chose HCF too as we never had any hassles ever from HCF.

When I had  my Brain stem stroke on 13th April 2000, I was rushed by ambulance to RPAH and admitted. Not having used HCF cover before when asked by admission staff we provided HCF details as requested.

I was too sick to even know what was going on and all I was praying for was to stay alive. I was not meant to live but did and next April it will be 20 years Post Brain Stem stroke.I owe my existence to a brilliant young neurologist Dr. Steve Vucic who I was not wrong in thinking would become a top neurologist of the future. Today is a Professor and Top Neurologist at Westmead.

I was there are RPAH for nearly 4 weeks and in the general ward.  They kept telling me there were no private rooms available except for the last three days before discharge. I wont be surprised if HCF was charged for the entire period. Did not give this much thought then.

In 2001, I consulted a Vascular Neuro Surgeon at POW-Private as I had recurring TIAs and was afraid of another hemiplegic stroke that would kill me. The surgeon suggested I get admitted and have an 'Angiogram with Dye' done. This was the Gold Standard and then he said he would decide what to do based on the results. I got admitted had the angio done and the surgeon suggested a PICA Bypass and explained what it would entail. Meanwhile I got my nephew to do Google searches on "PICA BYE PASS" and found out this procedure was banned in USA in 1985 as it was extremely risky and had a morbidity rate of 9/10. I also consulted my haematologist at RPAH who told me not to risk my life and take my chances and say No and I did and am still alive thank God for that.

What I want to share here is that neither the Hospital or the Surgeon wanted to discharge me from  Hospital POW Private and kept me in the hospital for ten long days for absolutely no reason. Yes I had a Private room in Hospital considering I was a HCF member and entitled to Private room.

Thinking back I now realise They just kept me there for no reason so they could charge HCF. Charging private Insurance companies was a good revenue source for Public Hospitals it seems but we the customers pay the price with ever increasing health cover costs

Just a few days before Christmas in 2002 I bust may Back in a very bad way. I have suffered from a Prolapsed disc since 1978 and God knows what I did, I could not get out of my water bed; the pain was excruciating. I was there all day and had to use the toilet; so finally we called the ambulance. The paramedics tried and gave up saying Sir we do not know how to help you get out of the waterbed and into the stretcher to take you to emergency. Think they were more concerned about causing further spinal damage. So they left.  I just lay there in bed abandoned for more than 24 hours and finally with help from family managed to get out of bed. We then organised for a physiotherapist to come home and give me deep tissue massage as I was in no position to drive.

Finally did get to Emergency at Concord Hospital where a CT scan was done. The good registrar told me Sir you probably require a spinal surgery but if you get admitted here now, you will be just in bed all Christmas and new year period as no surgeon is going to operate and if You want to choose your own surgeon Dr Steele, it might take even longer. Suggest you go home and come back in the new year and get admitted. that way you spend Christmas and new year with family, but please be extremely careful. So I went home.

On 2nd January I went back and got myself admitted as suggested by the Registrar. I was able to move around, the pain had subsided but believed a surgery was necessary and stayed on. 

I was kept there at Concord Hospital for ten days but the surgeon was away on holidays and did not come back until the 13th of January I think. I should have been discharged and sent home to return after the surgeon was back at work. Public Hospitals love to keep patients with private insurance as long as possible in the hospital charging them for Private rooms which were never made available. I was in a Public ward with other patients; I cannot forget this as in the next bed was a grump who complained about me talking on my mobile phone to family and friends any time of the day. Oh Yes he too had private health insurance and wanted his private room which he was not given. Very unfair to HCF and all health funds

It is different when your surgeon admits you for a procedure in a Public Hospital. You get your Private Room and the doctor discharges you asap and hospital admin has no say over this.

In 2004 again I had to rush to Concord Hospital emergency. This time it was a huge ulcer on my ankle bone. They did some quick blood tests and said they suspect it is a "White Tail spider bite" and I needed to be admitted and put on antibiotics. At that time there were no private rooms available at all and I was admitted to the geriatric ward the only ward that had a spare bed. The Triage Nurse whispered to me don't use your  Health Insurance as you don't need your doctors  and if you want to be discharged early.. I was sent home on the third day. Yes there are good people there always who look after the patents interests.

In Sept 2012, I was at a Chinese restaurant with my wife and realised I was having another stroke. Felt light headed and dizzy, slurred speech, had visual disturbances and severe nausea. The ambulance came and I pleaded with them to take me to either RPAH where they had my medical history or to Concord Hospital. No they told me that they had been instructed to take me to "Canterbury Hospital". Never been to Canterbury before and only when I got there I realised it was a dump and had no CT Scan or MRI/MRA facility nor did they have specialist consultants on Board. Why would they send a patient with stroke like symptoms to Canterbury Hospital ? God only knows. May be some one did not like my name and decided Canterbury was good enough for this migrant. 

 At Canterbury Hospital I was admitted in ICU and was administered Aspirin a blood thinner on top of my Warfarin and Plavix. Fortunately I did not bleed to death that night.

It was my good fortune that the following day I was seen by Neurologist Dr Penelope Spring. After thorough examination she said I don't see any neurological deficits  and think you may be extremely low on Vit B12. Meanwhile the admin staff came and took down details of my HCF membership and seemed extremely delighted. I was puzzled by this excitement. Believe it or not I was kept in ICU for seven days. May be they charge HCF more for ICU beds and then I was transferred to the dirtiest and filthiest Public ward where old men defacated and urinated all over the toilet. One kind nurse allowed me to use the staff toilet.

Not only that every second nurse came and thanked me for using my Private cover and I said yeah where is my private room ? they said none were free... don't know if they were telling me the truth..

What shocked me even more was the big Thank You Letter, I received from Canterbury Hospital for using Private Health Cover 

I think HCF should talk to patients and ensure that the Hospitals were charging them only for Private rooms that were occupied and not for the entire period where the patient could have been in a public ward.

This whole thing stinks as I can now see why the premiums are going up all the time, for Private Health Insurance cover.

I was  admitted to Mater Hospital in North Sydney in Jan 2018 for a Pace Maker implant. Being a Private hospital they discharged me the next day. Best Hospital Experience was at Mater Hospital in my four  decades in Sydney and I was in a public room yet it was sparkling clean.