More on the real costs of surgery...

We would be retiring early if we had a dollar for every time we’ve been asked “what does it cost to get sick?” in reference to what the cost gap will be for, say, a heart bypass, when covered by private health insurance.
 

As the saying goes: how long is a piece of string?? I always write stories when we hear of them, about specific cases and their costs; several Risk Reads were borne from these and that is absolutely the best we can do. Even when we tried to get a health insurance expert to tell you, at our conference this year, about average costs and average gaps and excess non-reimbursable expenses, he still couldn’t give you any real black-and-white answers.
 

That’s because there aren’t any hard publishable costs; there are only mile-upon-mile of varied case studies. It depends on a dozen variables, the most critical of which will often be “do you want a choice of treatment and/or doctor?” and the only time that can be truthfully answered is when the sufferer is facing going on the trolley and is feeling vulnerable. I am certainly convinced that a client who says they would be happy with the public health system will soon change their tune (and wouldn’t we all???) when faced with two diametrically opposed propositions and their life – or at least their quality of life - may be at stake??

 

In the Sydney Morning Herald two weeks ago there appeared an excellent and very topical example of this. Within the letters section a gutsy gentleman (who named himself in the letter) wrote:
 

“Aged 48, I was diagnosed with prostate cancer on Friday August 28 – National Cancer Day. Now September, it’s Prostate Cancer Awareness month. For years I have had top private hospital cover with a leading fund and have always presumed that if I needed an operation all costs would be covered.

It has been recommended I have surgery for removal of the prostate and the cancer using something called a da Vinci Robotic assisted operation, available only in one NSW hospital, a private hospital. The plus side of this form of surgery is I need to have only two or three nights in hospital and, hopefully, I will be off work for only two weeks. There is much less trauma, less pain and more precise results. There is also no waiting time.
 

If I were to have normal prostate surgery in any other hospital it would involve major trauma, with seven to 10 days in hospital and two to three months off work. I would probably have to wait for the operation. I checked my health fund’s details. The private hospital is one of my fund’s “participating hospitals” and the fund offers “your choice of doctor”. I thought I would have 100 percent coverage. When I rang my health fund to check I found I was wrong. There is a line in the brochure that says the fund covers the “Medicare Gap (25 percent of scheduled fee)”.
 

The scheduled fee is set by the government and my fund has advised that, like all health funds in Australia, that is all they are permitted to cover. The scheduled fee for prostate surgery is just under $1,500, but the cost of the robotic assisted surgery, the surgeon and the anaesthetist is nearing $12,500. I have to finance the enormous difference, the real gap – more than $11,000.
 

The fund pays all my room, nursing care and associated charges. But if I had conventional surgery, with a much longer hospital stay, I could have it done in the public system and there would be no enormous gap to pay. Am I missing something here?”
 

Well we cannot answer that particular question, but the situation described in this letter is another classic example of why you would not let your client take chances with their own choices at time of a trauma. I hope this gentleman has trauma insurance or the stress of finding a loose $11,000 change will certainly add to the emotional drain from his worrying diagnosis.
 

This is no place for a political comment so we won’t. There are two comments worthy of making:

1.     The reasoning behind this debacle for this patient is that modern, radical, new and beneficial

2.     surgical methods are like anything exclusive and special – they come at a price. Which would you rather have the capacity to pay for: the bog-standard treatment that everyone has access to (the downsides of which, in the case of traditional prostate surgery, are what led to this surgeon deciding to offer this new, wonderful alternative) or the expensive but much more beneficial robotic version???
Most of the privately insured population do not understand that in the majority of cases, the medical procedures carried out in hospital will be less than effectively offset by private insurance – it should be called hospital-not-medical insurance and that would be a clearer description.

3.     If a prospective client tried to tell you he would opt for the bog-standard, in order to stop you ‘flogging him’ trauma insurance – what would you say??



Tale of The Week

One of our members returned to work after an horrific time with his health. He sent me an email with some details. “Here’s an example of the sort of hidden costs I encountered which because of their timing and nature left me with no choice - but to pay up there and then. My surgeon (a hell of a nice guy) explained to me the day before the procedure [triple bypass] was scheduled that because I was a MediBank Private patient I would have no costs for the forthcoming surgery “apart from an $800 up front credit card payment” which he required, he told me, before the procedure was conducted.

 

Two anaesthetists were required, lovely blokes, huge fees.
Just for this year to-date, my out of pocket expenses exceed $16,000.”

He had trauma insurance - which had paid out after a prostate cancer diagnosis in 1999, but of course had no reinstatement-of-trauma clause then. So this is a good reinforcement of the value of the trauma reinstatement benefits available on modern products, which, if he had had one, would have paid this time around for the bypass surgery.

 thanx to 'the risk store' which we lifted this from

So which do you prefer ?

• your capital
• a premium that can be tailored for your budget
• other

you are welcome to call us on 07 3848 1088 or email us on info@wealthcoach.net.au or contact us through our website

 Remember we ask our selves.
' What would we do if we were you so that you are better off in three years time?'
 

John McAuliffe