Private health insurance Problems

Yesterday, I was in hospital again for a planned procedure. Hopefully that will be the end of the matter which started with my visit to the emergency room nearly a month ago. Ambulance Action It was my third admission, and due to the fact that my hospital admission excess of $500 is capped at $1000 per year, I did not have to pay this time. That's good. (So was the sandwich which broke an 11 hour fast, when I woke up after surgery.)

Of course I still have to pay for the surgeon, and as he charges above the scheduled fee, there will be a gap between what Medicare pays, what my health insurance pays, and the total cost. Ah, the dreaded gap. If you think private health insurance will cover everything? Think again.

[image error] Two more examples will suffice: I am booked in for another procedure next month (unrelated to previous misadventures). I was offered the choice to have it done in the surgeon's room, under local anaesthetic, or in hospital under general anaesthetic. The procedure costs $708. If I do it in the surgeon's room, I am considered an 'outpatient' and my health insurance won't pay anything. If I choose hospital, I am an 'inpatient' and the insurance will pay about $100. Medicare will pay just over $100 regardless. Either way, I am left once again will a gap fee.

My final example is orthodontia. When asked to explain why they would only pay half of the $7000 bill for my daughter's orthodontic treatment, the insurance company representative said that orthodontia was 'complicated'. What a cop out! What they meant was that they didn't want to pay for it.

Is private health insurance worthwhile? The above examples, and others I could cite would suggest perhaps not. If I paid myself the monthly premium, and put it into a health fund for myself instead of swelling the coffers of the insurance company, would I be any better or worse off? I wonder.


On the plus side, I do get two free pairs of glasses per year, I get pretty good rebates on dentist fees, and if I need to go into hospital I don't have to go on a long waiting list. There is also no charge for ambulance services.

For around $250 per month for me and my family, I think it's probably worth it. What do you think?

Photo source:
http://www.medindia.net/patients/insu...