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Why do we have waiting periods


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103 replies to this topic

#1 cinnamonnutmeg

Posted 12 December 2019 - 08:19 AM

On Private Health?

I am currently in my 12 month waiting period on my PH to get weight loss surgery (my surgeon doesn't operate without insurance). Waiting is the pits.

I understand that they don't want people signing up for a month,  getting major surgery and cancelling.  But why can't you just pay for a year with no refunds if you claim and then do what you need?

Why make us drag things out for x months while things potentially get worse?

Is there an actual reason or is it just because?

Thanks!

#2 Soontobegran

Posted 12 December 2019 - 08:26 AM

Because one years contribution would not go anywhere towards paying for the actual costs of your surgery.

#3 seayork2002

Posted 12 December 2019 - 08:26 AM

Well I presume there is an actual reason and not something they made up a Christmas Party to annoy people.

But yes I would assume it is connected to people signing up getting work done and then leaving

View PostSoontobegran, on 12 December 2019 - 08:26 AM, said:

Because one years contribution would not go anywhere towards paying for the actual costs of your surgery.

And that too!

#4 born.a.girl

Posted 12 December 2019 - 08:28 AM

Isn't what you're suggesting 'pay for a year with no refunds' much the same as them making you wait for a year?

Or are you saying you should be able to pay a lump sum for the previous year, then be eligible for treatment from day 1?

Same reason, people needing hugely expensive surgery all of a sudden, would pay several thousand dollars, then get the benefit of many tens of thousands of dollars back from the fund, then still cancel.

The idea is you pay insurance for 'if and when' you need it.  If you haven't done that, you wait.

It's the same reason you can't sign up for your house insurance and get instant cover, when you see the flames licking at the door.


ETA: Why would anyone have PHI if you could just pay up for the whole previous year, then be eligible to claim immediately?

Edited by born.a.girl, 12 December 2019 - 08:30 AM.


#5 MissHLH

Posted 12 December 2019 - 08:29 AM

It's exactly the reason - they don't want people signing up, paying next to nothing into the system, and then leaving.  They're a business, their aim is primarily to make money, not help.

#6 Soontobegran

Posted 12 December 2019 - 08:42 AM

I think there is an issue with people not understanding the actual costs of surgery...either via Medicare or using PHI.
The actual annual contributions we make are never going to cover much more than a very simple surgery.....you need to show loyalty to an insurer and pay even when you don't need to use them to reap the benefits of insurance.

Many people who pay PHI will happily go through life never having to make a huge claim and many people will pay the same and make huge claims......it's insurance.

#7 -Emissary-

Posted 12 December 2019 - 08:56 AM

The cost of 1 year worth of premiums isn’t enough to cover the cost of the surgery.

They want to stop people from signing up just when they need the surgery and cancelling. The fear of waiting 12 months keeps people paying premiums for years when they don’t need it yet.

At the end of the day, private health insurance companies still needs to operate at a profit. They won’t be if they give everyone an option to just sign up when they need it.

Edited by -Emissary-, 12 December 2019 - 08:57 AM.


#8 MissBehaving

Posted 12 December 2019 - 09:00 AM

View PostMissHLH, on 12 December 2019 - 08:29 AM, said:

They're a business, their aim is primarily to make money, not help.
Exactly. And even better if you die while waiting because they don't have to pay anything for you!

#9 seayork2002

Posted 12 December 2019 - 09:13 AM

View PostMissBehaving, on 12 December 2019 - 09:00 AM, said:

Exactly. And even better if you die while waiting because they don't have to pay anything for you!

Then don't get insurance and pay for what it costs yourself

#10 CallMeFeral

Posted 12 December 2019 - 09:28 AM

The premise of insurance is to have it all the time, 'just in case'. If you don't have the 'just in case' people paying while not using, you don't have enough to cover the 'I need it now' people.
Waiting periods encourages the 'just in case' membership that the whole insurance model is based on, and discourages the 'I only want to pay money when I need surgery' membership, which really is nothing to do with insurance, it would involve just paying full surgery costs when they come up, out of the money you've 'saved' by not having insurance all the time you didn't need it.

#11 #notallcats

Posted 12 December 2019 - 09:30 AM

But the OP can sign up, wait one year, and still cancel after surgery.    

What's she's saying, is why can't she just pay two years in advance and not have to wait.   Either way, it's the same.

#12 can'tstayaway

Posted 12 December 2019 - 09:32 AM

View Post-Emissary-, on 12 December 2019 - 08:56 AM, said:

They want to stop people from signing up just when they need the surgery and cancelling. The fear of waiting 12 months keeps people paying premiums for years when they don’t need it yet.
Yes. FIL was always reminding us to maintain our PHI even though we were young and healthy but with tight finances. His fear of waiting periods was instilled in DH and we’ve probably paid into the six figures for premiums.

A few years ago, DH required surgery after an accident and it would have cost several times the amount we paid in premiums. Let alone having access to doctors/hospitals who won’t operate on uninsured patients.

#13 #notallcats

Posted 12 December 2019 - 09:38 AM

What is the reason Dr/hospital won't operate on uninsured patients (assuming they have the money)?  Sounds unethical to me.

Does insurance pay out ALL costs?  Doesn't medicare cover some anyway?

#14 Moukmouk

Posted 12 December 2019 - 09:44 AM

View Post#notallcats, on 12 December 2019 - 09:38 AM, said:

What is the reason Dr/hospital won't operate on uninsured patients (assuming they have the money)?  Sounds unethical to me.

Does insurance pay out ALL costs?  Doesn't medicare cover some anyway?

It depends on the procedure. Simple day stay surgery with well defined costs - sure, and doctors do it all the time. Things like cataracts, grommets, tonsils, wisdom teeth. A big surgery like a hip replacement with unpredictable outcomes? The patient might need a longer admission, ICU etc. It's not ethical to lump them with a bill that could be hundreds of thousands of dollars. And medicare doesn't cover the costs of the private hospital admission.

#15 MissBehaving

Posted 12 December 2019 - 09:48 AM

View Postseayork2002, on 12 December 2019 - 09:13 AM, said:



Then don't get insurance and pay for what it costs yourself
I don't have PHI and never have ;) No need for snark though, I was only answering the OPs question.

#16 seayork2002

Posted 12 December 2019 - 09:49 AM

View PostMissBehaving, on 12 December 2019 - 09:48 AM, said:

I don't have PHI and never have Posted Image No need for snark though, I was only answering the OPs question.

I was not being snarky just stating an option

#17 alchetta

Posted 12 December 2019 - 10:05 AM

View Post#notallcats, on 12 December 2019 - 09:30 AM, said:

But the OP can sign up, wait one year, and still cancel after surgery.    

What's she's saying, is why can't she just pay two years in advance and not have to wait.   Either way, it's the same.

Because insurance companies rely on decades worth of payments and couldn't survive if they permitted people to only pay two years' worth.
Nobody would buy insurance if they knew that on the spot in case they needed it, they could just cough up a fixed price two year insurance premium and access surgery worth substantially more.

#18 born.a.girl

Posted 12 December 2019 - 10:07 AM

View Post#notallcats, on 12 December 2019 - 09:30 AM, said:

But the OP can sign up, wait one year, and still cancel after surgery.

What's she's saying, is why can't she just pay two years in advance and not have to wait.   Either way, it's the same.


Because that would still encourage people waiting until the last gasp, then paying a fraction of what it would cost to be privately insured over several years.

It's not the same.

Having to wait a year is why the rest of us have it 'just in case'. We pay for years and years and years, in case we need it, not just one year.

If everyone only had to pay for two years for major surgery the system would fail.  People would actually have to be paying the full cost of their surgery, effectively, because there'd be no one subsidising them.

It's my contributions of $4k each year that are even enabling people to only have to wait one year.

I wouldn't be surprised if the waiting times were made longer for things that can be vaguely anticipated (obviously a government decision) in order to keep the cost affordable in the future.

#19 born.a.girl

Posted 12 December 2019 - 10:12 AM

View Post#notallcats, on 12 December 2019 - 09:38 AM, said:

What is the reason Dr/hospital won't operate on uninsured patients (assuming they have the money)?  Sounds unethical to me.

Does insurance pay out ALL costs?  Doesn't medicare cover some anyway?

It's not unethical.  Imagine you end up in intensive care, needing extensive medical attention that you'd not budgeted for.

We don't want to end up like some in America, where 52,000 people are year become bankrupt through medical costs.

Many surgeons have an OOP even after medicare and PHI.  My last one was $2k.  If I have my shoulder reco done it will be $4k oop.  I could go to someone who has an arrangement with my health insurance fund, but the one I want to do it, doesn't.

Imagine the furore if someone went to the trash TV channels with their hard luck story of poor health landing them in intensive care, and the doctor sending them bankrupt.

Nope, you have the cover beforehand, or you use the public system (generally speaking).

View Postalchetta, on 12 December 2019 - 10:05 AM, said:

Because insurance companies rely on decades worth of payments and couldn't survive if they permitted people to only pay two years' worth.
Nobody would buy insurance if they knew that on the spot in case they needed it, they could just cough up a fixed price two year insurance premium and access surgery worth substantially more.

Exactly. What a bargain that would be.

Even just allowing 12 months wait, the hope is that the person will realise that it's worthwhile holding on to, so they don't have to go through that again.

#20 Manicmum

Posted 12 December 2019 - 10:19 AM

They do it because the waiting is the annoying part especially if you are in pain. And don’t fall for the old.. if you're in an Accident you will be covered anyway.. maybe for the broken bones, but what about rehab, you could be a long way from home for a long period!

#21 #notallcats

Posted 12 December 2019 - 10:20 AM

Lots of people have PHI for the perks, like dentist, massage or pre-existing conditions.   So I think people wouldn't just wait until they needed an operation to have it.  

It doesn't sit right with me hospital/dr not operating unless you have insurance.  That actually sounds like the USA system.  We all know the public system is busting and wait times can be long.  So it's not a matter of just go through the public system.

#22 born.a.girl

Posted 12 December 2019 - 10:41 AM

View Post#notallcats, on 12 December 2019 - 10:20 AM, said:

Lots of people have PHI for the perks, like dentist, massage or pre-existing conditions.   So I think people wouldn't just wait until they needed an operation to have it.  

It doesn't sit right with me hospital/dr not operating unless you have insurance.  That actually sounds like the USA system.  We all know the public system is busting and wait times can be long.  So it's not a matter of just go through the public system.

That's extras, which is completely separate.  No one's going to pay hospital insurance for extras.

What would you suggest happens if people can't pay an unexpectedly high private hospital bill?  Just have it waived?  Or should they pursue it?  THAT is the USA system, not ours.

The public system is definitely busting, it always has been as far back as I can remember, especially for lower category surgery.

However if you have a heart attack you will be treated quickly in first class hospitals by top professionals. That doesn't happen in the US.

That's the sort of thing sending people bankrupt in the US.  Surgery you can wait for, even if it's not in comfort, or is optional is zero reason to go into debt and become bankrupt.

#23 JBH

Posted 12 December 2019 - 10:53 AM

Think about how you feel now - probably, gee I wish i’d had insurance. If you’d been able to pay and access surgery immediately, you’d be perfectly happy with the approach of not previously having insurance. Insurance companies need to inspire both backwards looking “wish i’d had insurance” and forward looking “better have insurance so I won’t have to wait” feelings. The “pay when you need it” model is actually to pay the whole cost of the surgery.

#24 Hibiscus123

Posted 12 December 2019 - 11:22 AM

Insurance is to insure against risk, rather than definite outcome.

If you obtain insurance for surgery that you intend to get In The immediate term, then you’re basically asking for a free handout from the other policy holders

#25 gracie1978

Posted 12 December 2019 - 11:34 AM

As someone who has paid for top cover for ten years it really annoys me that people sign up for insurance, get the surgery and then cancel straight after.

The waiting period is meant to be an inconvenient disadvantage for not having contributed.




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