The cost of in­sur­ing your health

Auckland City Harbour News - - NEWS -

I went un­der the knife this week and learned a few things about health and money.

A few weeks back I de­vel­oped dam­age to my right knee and an MRI scan showed a tear in a thing called the menis­cus which re­quired surgery to fix.

With an Igor-like limp and a semi-per­ma­nent scowl from twinges of pain rang­ing from nig­gling to pierc­ing, I felt like I’d be­come old overnight and I was keen to be re­turned to the happy pre-hurt me.

Thank heaven I have med­i­cal in­sur­ance. Three weeks af­ter see­ing my GP I was in for my op­er­a­tion.

You see, I asked the spe­cial­ist what would have hap­pened were I unin­sured. Five months wait for an ap­point­ment with him and an­other five months for surgery.

The worst case sce­nario dur­ing such a wait was dam­age to the car­ti­lage and I don’t have to tell you what hor­rors that can lead to as you age.

There would have been an­other course of ac­tion: Lie through my teeth to my doc­tor and ACC and claim that I had hurt it in a trip while run­ning. The wait would have been longer for ACC to de­cide whether to make me fight them to get the claim paid but it would have been shorter than on the state.

The same hurt, three dif­fer­ent waits for treat­ment. Quite sober­ing.

But what I also learnt is some­thing I should blush to ad­mit. I didn’t re­ally know what my med­i­cal in­sur­ance cov­ered me for. Oh, I knew my South­ern Cross pol­icy was what is termed ‘‘shared cover’’ but I hadn’t twigged that there was a sched­ule of max­i­mum pay­outs for dif­fer­ent classes of surgery and that de­pend­ing on the sur­geon I went to and the anaes­thetist the sur­geon chooses, the gap that I would foot could be a big one.

Over­all the bill (ex­clud­ing the $1000 MRI scan which I have to chip in $200 for) will be around $6200, of which I’m up for roughly $2000. I pay 20 per cent share of the op­er­at­ing the­atre hire and costs of $3732.55, which is just un­der $750.

There’s an­other few hun­dred bucks for my share of the anaes­thetist and as it turns out I was sent to a more costly sur­geon (and one my friends at ACC de­scribed as ‘‘one of the good ones’’ breath­ing a sigh of re­lief for me).

You see, when my doc­tor sent me to a spe­cial­ist he was not there to con­sider the health of my bank bal­ance, just do his best for my knee. The gap I expect to face is some­where be­tween $750 and $520 on the $1650 sur­geon’s fee as the max­i­mum South­ern Cross will pay out is the ‘‘me­dian’’ price of that op­er­a­tion in the mar­ket­place.

But I didn’t know this when I trot­ted off to the spe­cial­ist and when I got the es­ti­mate for my op­er­a­tion I was rather shocked at the gap.

I was in pain. I was wor­ried. I was in no po­si­tion to seek out an­other lower-cost sur­geon and be­gin the wait­ing game again.

So what have I learnt? If I were with­out med­i­cal in­sur­ance and un­will­ing or un­able to stump up $8000, I’d still be limp­ing around risk­ing far worse dam­age.

If I were on a tight bud­get, I should have pre­ferred to be sent to one of South­ern Cross’ ‘‘af­fil­i­ated providers’’ with whom it has ne­go­ti­ated lower prices.

Health in­sur­ers need to do more work with doc­tors and pol­icy hold­ers to help peo­ple un­der­stand how to man­age the cost of their care.

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