Private health insurance/ medicare cover for complication

[plurbit]

hi guys! so im getting a BA next month and i was just thinking if should start buying a health insurance. i know that most health insurance would have a waiting period but even so i thought i might need it somewhere along the way if i have implants anyways.

 

in the case of not having a insurance, how much would medicare cover for complications? and if i do have health insurance would that significatly lower my out of pocket cost?

[Usplusthree]

If you get a medicare item number for something, which if something goes wrong you would I *think* medicare cover 75% of the scheduled fee for the doctor and anaesthetist and private would cover the relevant hospital fees and the other 25%. I think that's how it works. I'm still rather confused on it all myself. 
We have private for many reasons so it was just a perk with the procedure.

[Jaddles]

Nup, Usplusthree is close, but not quite there. So once you have a complication you are eligible for a Medicare number. I had CC which was covered capsulectomy, and implant replacement. So depending on your complication deets, medicare assigns a scheduled fee. The problem is that what a plastic surgeon charges (PHI doesn't pay for cosmetic surgeons since they are not specialists) you can still be out of pocket. From memory, my complications scheduled fee was $700 odd per Breast. So medicare paid 75% of that, and PHI paid 25% of that to my PS plus (pending, claim still in progress) the cost of replacement implants and (already paid out) my hospital costs were 100% covered (excluding excess). My surgeon only charged the scheduled fee (bless him), anaethesists did the same so my only out of pocket cost was $500 excess on my PHI, and a few dollars for a packet of Endone.

Anyway, if you're bright enough to be considering the very likely chance you'll require a revision sometime in the future (Breast implants are not a lifetime device, worrying considering the 'let's get a loan and go to TCI' brigade on here), please make sure you discuss revision policy with your surgeon, and know that if something goes wrong, no-one recognises a cosmetic surgeon as a specialist. pHI or Medicare. If you're thinking ahead, it makes a heap of sense to stick with a PS.

[Win]

I had a complication early on & spent 3 nights in a private hospital. Thankfully we have top hospital cover so no charge. I am still waiting on the PS & anaesthetist bill (very scared lol) but already we are out of pocket over a thousand dollars for the ER admission, ultrasound & pathology & that is with PH & medicare rebates.

 

So smart of you to be thinking ahead! Hubby & I discussed complications early on & also how many revisions we would be willing to pay for before we gave up if anything went wrong like CC or double bubble (which I am at a higher risk of) etc

 

I completely agree with Jaddles about seeing a PS if you're thinking this way. It was very important to me to go to a surgeon who would be able to fix any complication I had and not have to send me on to see someone else. 

 

Good luck with it all I hope everything goes really well for you & you don't have to worry about any of this  

[savag28]

If it raises a Medicare item number then u will be covered up to the scheduled fee. Anything charged above would be out of pocket. Accom and theatre would be full covered also if this was the case.

[donatella]

Yes yes you should! I suffered CC and rupture repaired at 7 years post op and was only out of pocket $5000, would have been double this without PHI. They covered hospital, new implants, rebate for PS, anaesthetist and Meds etc.

Implants do not last forever, everyone will need a revision at some stage regardless of implant type and placement etc, initiate an emergency plan so as not to be devastated when it happens

[Anna]

If you get a medicare item number for something, which if something goes wrong you would I *think* medicare cover 75% of the scheduled fee for the doctor and anaesthetist and private would cover the relevant hospital fees and the other 25%. I think that's how it works. I'm still rather confused on it all myself. 
We have private for many reasons so it was just a perk with the procedure.

hi.So with insurance which do you get?id like to get one too and is there one you would recommend?