The cost of insuring your health
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.