September 27, 2019

Sarah Nix has been left more than $30,000 out of pocket because of ongoing surgeries despite spending $5000 a year on private health insurance



The situation of the poor woman grieves me but she is placing the blame in the wrong quarter.  If private insurance were to cover ALL medical costs, the premiums would be unaffordable. Basically, private health insurance covers HOSPITAL costs only.  It does not pay for the doctors and others who operate there.  So you have to pay them yourself.

And if it is only one adverse medical episode you have, most people will be able to do that.  In cases like Ms Nix, however, who needs multiple surgeries, that can easily become impossible.  Private health insurance is not for people in her situation.  It is the public system that she has to turn to.  Only the public system covers BOTH hospital and doctor costs.

So it is the public system that Ms Nix should be condemning.  And their services do leave much to be desired.  The care you get in public hospitals is not much  worse than what you get from private doctors and may be as good.  As Ms Nix points out, the big problem with the public system is the WAIT you have to undergo before you get in front of a doctor or surgeon.  And that wait can be very distressing.

So what is the solution?  Unless someone invents a money tree, there is only one solution:  Public hospital services have to be rationed in some way.  Self-inflicted injuries and illnesses in particular should not be treated: Damaged joints caused by obesity and lung cancer caused by smoking for instance.  People suffering from such illnesses could probably take out special insurance for their needs.  But people who are ill through no fault of their own should always be at the front of the queue.

That is unlikely to happen -- though something like that does often happen informally.  So we have to go back to money.  A small charge could be levied every time a person attends a public hospital -- a charge equal to the price of a packet of cigarettes, for instance.  Such an idea was discussed in Tony Abbot's time but was abandoned as poltical poison.  So we are probably stuck with distressing waiting lists.

A compromise that is already used for cancer patients is to give them special priority but even that can be a dangerous delay.  It might help a little, however for similar priority to be given to people in need of multiple surgeries, such as Ms Nix


Sarah Nix has run out of money and is now being forced to make a life-altering decision.

The 26-year-old from Brisbane and her husband Matthew can no longer keep affording to fork out thousands of dollars for her endometriosis surgeries on top of the $5000 a year they already pay for their private health insurance.

Mrs Nix was diagnosed with the debilitating condition that causes tissue similar to the lining of the womb to grow outside it two years ago. Her pain is so horrendous she hasn’t been able to drive or work for the past 18 months.

But on top of the horrific pain, Mrs Nix has the added burden of ongoing medical bills.

And she’s not the only one — tonight’s episode of Insight on SBS highlights how patients are paying high out-of-pocket fees for specialists and surgeries, from people who have had cancer to those with disc problems.

When Mrs Nix tallied up her costs, she was actually worse off than some of the cancer patients. “I’ve had five surgeries in total but it just keeps coming back,” she told news.com.au. “I can’t get rid of it.”

She estimates the surgeries plus everything else have put her out of pocket more than $30,000, with lost wages of $14,000 on top of that.

The couple had to get rid of their car and have set up a GoFundMe page to try to recuperate some of the costs.

“We have top hospital and top extras but they only cover my bed stays,” she said. “Private health is really misleading. “I always thought I was covered, but no.”

But Mrs Nix said she couldn’t afford not to have insurance, with waiting times in the public system too long. She’s had to wait more than three hours for pain relief presenting to a public emergency department compared with five minutes in the private system. “I wouldn’t get that in the public system so I can’t afford not to,” she said.

“But at the same time I can’t afford to keep it because it doesn’t cover anything.

“The public system isn’t good enough — it’s a 12-month wait for surgery and to see a specialist is a few months.”

Mrs Nix said on one occasion she was in so much pain her doctor made a decision to perform surgery on the spot, a luxury she wouldn’t get in the public system.

Now Mrs Nix is being forced to make the harrowing decision of having a hysterectomy when the couple were planning on having children.

“We just can’t keep affording to pay for surgeries, so my husband and I have made the decision if by the end of the year I’m still in pain that’s what I’m doing,” she said.

“It sounds like a hard decision as a young woman, but you know when you are in so much pain that you just want to end it, no matter how you do it? Financially, we just can’t continue this way. We’ve got nothing left.”

That surgery will also cost between $2000 and $6000.

“A lot of people are calling on the Government to change it (private health insurance), but I’m calling on private health insurance companies to change,” she said.

“I remember when I was a kid private health used to cover everything, whereas now it covers nothing. If they fix that our public system would probably be better off because more people would take out private health.”

SOURCE 

ADDENDUM:

As most people reading this will be aware, you can get a range of cover for "extras" with private hostpital insurance. And for services that are not too dear and not too often called upon that can be worthwhile. The cover is for such things as spectacles and hearing aids and dental costs up to a limit.  A small contribution to some "in hospital" costs can also be available.

I have maximum ("top") cover so my experience might help others to get a grip on what is available.  The premiums I pay to my fund (CUA) are higher than most but they are unusually generous with hearing aids.  My last lot cost nearly $4,000 and they paid nearly half of that.  I rarely have dentistry and what I have is simple so last time they paid all my costs.  There was also a substantial benefit for new spectacles.

But the most interesting case is what it cost me for my recent big cancer surgery. I was on the table in Brisbane Private Hospital within a week of the cancer being detected. I was in intensive care for a couple of days afterwards so that would have generated an enormous bill from the hospital which my fund paid in full.

The surgeon and her assistant sent me a bill totalling over $5,000, of which Medicare paid $1500 and my fund paid nearly $500.  So I was around $3,000 out of pocket.  In my younger days however I lived frugally and was able to put aside substantial funds to cover "a rainy day" -- so $3,000 was no problem.  Savings are the true health insurance.  It's towards the end of your life that you incur most of your life's medical bills. Proverbs 6:6-8 refers.





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