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PHI confused

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#1 GreenEyedGirl

Posted 21 January 2013 - 02:40 PM

I have PHI with medibank pvt & am having orthopaedic surgery tomorrow for a broken ankle at Wesley Brisbane.
Confused what will be covered by PHI
I have had IVF and my doc and stay have been covered but anaesthesiologist has not. Wondering if this will be the same.
Anyone know?
Tried calling medibank but can't get through!  huh.gif

#2 handsfull

Posted 21 January 2013 - 04:38 PM

Ring your surgeon and ask what the out of pocket (GAP) will be for the surgery and what the anaesthetist is going to cost you.

PHI covers your hospital stay but if the Dr charges a gap they do not cover that and you have to pay them that.  You can claim back at tax time.  Also depends on the level of cover you have as to what is covered, ie. some levels of cover only do certain types of surgery, top hospital cover normally covers every type of surgery.   Depends on which one you have.  MBP are generally very good.

GL for tomorrow.  Hope the gap is not too much.

Edited by handsfull, 21 January 2013 - 04:39 PM.

#3 GreenEyedGirl

Posted 21 January 2013 - 04:45 PM

Well I have mid hospital 250 excess + smart choice extras

Regardless I have to have the surgery whatever it ends up costing. Will ask when go into hospital though.

Would the fact that I was in hospital 3 mnths previously make any difference.

So confused what between what medicare covers and PHI covers!!!

#4 JRA

Posted 21 January 2013 - 05:23 PM

you need to understand these things. You are paying a lot of money for PHI.

A specialist I believe must, if not should, give you details of your out of pocket expenses.

The amount out of pocket depends on so many things. The anaesthetist will be covered. But often for an anaethetist there can be a LARGE out of pocket.

Your PHI may may have an arrangement with the hospital/surgeon/anaethetist that means there is no out of pocket. Once again you can check.

They should have given you a quote including how many "units" or such of anaethetist time/billable units.

Good luck

#5 rjflc69

Posted 21 January 2013 - 05:33 PM

My experience with Medibank Private (with the same cover) and out of pocket expenses

$250 hospital excess (resets in January so you will have to pay this on admission)

Anaesthetist - some covered by PHI & Medicare but paid a gap (we paid between $120 - $250)

Surgeon - some covered by PHI & Medicare but paid a gap with some not others (up to $500 if Medibank preferred surgeon)

X-rays/scans while in surgery - some covered by PHI & Medicare but paid gap every time (up to $120)

Hope that helps a little and good luck with your surgery


#6 barrington

Posted 21 January 2013 - 05:39 PM

Your orthopaedic surgeon should have given you the name and contact number of the anaesthetist that will be doing your case tomorrow, so that you can call their rooms directly for a quote.

If it is a non-urgent case, in most cases the anaesthetist's rooms will call you in advance with their fees.  But if the surgeon does not notify the anaesthetists rooms (in situations where you are added to their list at the last minute), then they are unable to call you to give you their fees in advance.

The fact you were in hospital three months ago will make no difference to how much you are charged by the anaesthetist.  I would be expecting to have an out of pocket cost.

Good luck tomorrow.

#7 GreenEyedGirl

Posted 22 January 2013 - 08:54 AM

Last surgery I had was an emergency ectopic removal and I obviously got no quotes as found out and was rushed straight into hospital.
The anaesthetics bill was $650 when I got it. It said not to go to my PHI or Medicare as they would file directly, so not sure if anything got rebated there... been so caught up in things I have not checked.

Again this surgery is pretty urgent to and I saw the surgeon yesterday and having the surgery today.

Anyway as I said I have to have the surgery regardless of costs involved. Just wanted to get an idea .... i will ask  when I go into hospital

#8 Expelliarmus

Posted 22 January 2013 - 09:03 AM

The anaesthesiologist has been covered but you have to pay a gap fee. It's standard to send you a bill for the gap and they file for the Medicare and PHI rebates on your behalf. $650 gap for anaesthetic is fairly standard, a little higher than I usually pay but not by much. They should have given you, or you can request, an estimate before surgery.

#9 MrsLexiK

Posted 22 January 2013 - 09:11 AM

Oh you will also get stung with excess again as it is once year sad.gif

#10 GreenEyedGirl

Posted 22 January 2013 - 10:29 AM

The anaesthesiologists office called and said out of pocket I should be $200 so they will bill me for that.
So that is all good.
Surgeons office is finding out what my out of pocket expenses will be and letting me know soon.
Hopefully it is not too much.

More than this its me not being able to work for 4 weeks that is going to sting!

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