My husband his thinking about moving back to Australia, so i have some questions. if i buy private insurance how long do you have to wait before you can get them to cover the lab band?? how much are you looking at for insurence?? i would like to lose the wait before we move but the surgery will cost me over $16000 plus $4000 for travel, here in Canada. anything else i should know??

thanks

Andree

Hi there.

For me, I had to be a private health fund member for over 12 months @ $240 per month ( familly cover ) Which i already had been in anyway.

Then the process took about 3 months total from the first local doctor visit untill surgery day.

And after claiming it all back , the costs all up ( local doctors, drugs ect )was @ $4000.00 Total out of pocket.

My surgeon though you pay an up front fee is for everything. surgery, fills, later complications, ( if there is any ) everything..

Mark:)

wow lucky you, my husband would like to know the name of the company?? and is it hard to get approval??? my bmi is 45 and Im 5.6.

where do you live???

thanks for your help

Andree

http://www.andreerichards.piczo.com/?cr=7&rfm=y

I had a similar experience and decided to pay for my own because my new insurance company stand down time was one year. The total cost to me was around $7,000. Medicare picked up some of the costs and also cover all of the fills. I see my doctor every month and have had about 8 fills. My new health insurance stand down time is now over and if I have any trouble, they will now cover any further band related operations (should I need it). I could have waited on the Public Health waiting list also but just wanted the band as soon as possible after moving here. I'm glad I did it this way.

Brenda

hi there

i am living in melbourne and recently went to visit the surgeon. Initial visit was $120 ( $60 ) refund from medicare. If you are prepared to go on his waiting list which could take between 6 to 12 months, the operation, fills and future visits are free and dealt with by all the same surgeon

Hello. I have private health insurance, and I have had to wait for twelve months before being able to have the surgery. I will also have to pay about $4,500 AUD which covers the surgeon's fee, tests, fills etc etc. No more to pay. I think it is a good investment in your health.

Come back to Australia, it's the best country on earth!:girl_hug: Susannah

You dont have to "get approval" in Australia, if your surgeon will do it your health insurance will pay. Obviously you couldnt get a lap band at a BMI of 20, but generally 30+ is grounds enough, if you've dieted, if you're just getting heavier by the year, you dont have to prove co-morbidities to the insurance co. Its basically whether or not your surgeon will do it and you can probably surgeon shop anyway till you find someone you like, who is on your wavelength since Medicare will pick up a good deal of the cost of the consultation.

It was a quick process for me, less than 3 months, and I was another who payed upfront so that I'm bulkbilled for everything - all fills and consultations - forever after - which basically means that Medicare is charged direct by the surgeon and he charges on the scheduled fee for those visits.

Our health system is really great, as is our education system. You can also be done under the public health system if you dont have private health insurance but that differs enormously - with the group of surgeons I went with it wasnt an option since a lot of surgeons want you to have insurance in case of revision surgery, they strongly advise that you do NOT take out insurance, have the surgery and then drop it, and in many areas you could wait five years or more for a spot on a public list, then again, there's areas in Melbourne and I know in Perth also where you can be done within months. Just depends.

Thanks you guys, you are great help Im ready to go and pack my bags lol

even more now that i have frostbit on my legs.

Im sure i will come up with more questions some other day

Andree

Hey Susannah, I had the same surgeon! He's put his prices up though, lol.

When you go to buy private insurance, do you ask for a special package or is the lab band cover in everything??? If you pay for the lab band your self how much are you looking at????

andree

You dont ask for "special" cover. Policies differ in what they offer and I believe at one stage when we were young and newlywed we did have a health insurance policy that excluded certain things like cardiac surgery, stuff we felt really positive we wouldnt need at that age. But your stock standard health insurance policy will cover almost everything apart from cosmetic surgery and other really unceccessary (from a medical viewpoint) surgery.

Where they differ is in the extras. You can elect to have (or not have) optical, dental, physio, chiro, naturopathy, stuff like that and the amount of hospital cover they provide - blue ribbon cover will mean you get your total hospital costs paid without any excess paid by you for instance.

What happens is that our public health system, Medicare, pays for most things for everybody. Medicare will pay 85% of the scheduled fee for all conceivable services (but doesnt cover optical, dental or physio and the like). Most physicians will charge more than the scheduled fee for their services, so you have a "gap" by which you are out of pocket. Some health insurance policies have gap cover and will refund a portion of this gap, but you will almost always be out of pocket slightly, but not by an awful lot. In this way, anyone with or without insurance can seek out a surgeon, you dont have to wait months on a public list to get in to see him for "free" unless you cant even afford the gap. If you dont have private insurance though and you need an operation through the public system, you dont have the freedom to choose your specialists, you get who you're given.

So Medicare will pick up much of the cost of surgery, anaesthetist etc and your health insurance will pay for your hospital bed basically.

Then what most lap band surgeons seem to do is charge you a once off fee that is not covered by your health insurance or medicare (since its above and beyond the scheduled fee), mine was $3000, and all your aftercare is covered after that since the surgeon only bills the scheduled fee direct to Medicare so you dont pay for fills or anything.

If you went self pay, it would cost you around $20,000 or more probably and of course, Medicare would cover a fair bit (85%) of that, so you wouldnt be out of pocket by that much. But you'd have to pay it and then go to Medicare for the refund.

The trouble is, many surgeons wont accept self pay becuase of the difficulty with aftercare - people tend to be slack on their review and fills because they cant continue to find the money, a fill may cost you $250 or so each time, and if they need revision surgery they're stuffed - again Medicare will pick up a lot of the cost but not for the hospital and you could be paying $1500 per night for a bed etc. You can go self pay on most things though if you so desire, such as having a baby or getting your child's adenoids removed etc.

You really do feel thankful for your private health insurance though when you're 32 weeks pregnant with a broken hand that has been unsuccessfully set in plaster, and hasnt healed and you go back to your surgeon and demand that he fix it surgically becuase you're about to have a baby and you need your hands dammit and he looks at his watch and says "can you meet me at the hospital in half an hour?". I'd still be on public waiting list for that one, and my hand would be ruined.

There are a few anomolies in our system though, to have a baby through the public system cost you pretty much nothing, but having the "priviledge" of private health insurance means it cost me about $3,000 per baby, lol. Still private hospital, five day stay for a normal birth, decent food, Doug staying the night, private obstetrician who attended me for all 3 births, it's worth it to me rather than going into a public hospital, giving birth assisted by whomever happens to be on duty that night and having to go home the next day.

Susannah,

I was done at the same clinic only a few months ago and my up front cost was $3060. Have they increased their costs or added in extras?

Hi Tara and Jachut, Mr Crosthwaite's fee is $ 3,500 now. As I have MS I have had to have much more testing and consultations with my neurologist also. So if I ad up all my costs, it will be approx $ 4,500 Aud for me. It would be cheaper for others who don't have an additional medical condition etc. Susannah

Ah, yes I remember him telling me to pay ASAP becuase he was putting his prices up

I would pay that anyday over $16000

andree

When you go to buy private insurance, do you ask for a special package or is the lab band cover in everything??? If you pay for the lab band your self how much are you looking at????

andree

The rules are different for permanent Australian residents and others, so exactly what happens in your case would also depend upon your residency status.

Australians enjoy a government subsidised health care system. Australian taxpayers pay a Medicare Levy as part of their income tax assessment. It is means tested, and usually works out at 1.5% for most average wage earners. A higher levy is charged if you don't have private health cover. For people who do have private health insurance, 30% of the premium is tax-rebateable. There is also a Medicare "Safety Net" when medical expenses are over a certain amount per year ($1250??). I am not sure of the details, but understand that this year we will qualify for this, and as a result have an additional rebate or a reduced Medicare Levy in our tax return at the end of this financial year.

It pays to check what your policy covers, as they do differ. However, generally the story is that once you have qualified for the waiting time on the policy, and the surgeon says you need the procedure, you are covered. End of story.

I think without insurance, and without waiting on the public list, the lapbanding would cost between $15,000 - $20,000. I am not aware of any Aussies who have done this, but there must be someone somewhere.

I went through the same surgical centre as Oldspark (Mark), and had similar out-of-pocket costs (just over $4,000), including all consultations, procedures etc, pre-surgery diet products, and some exercise equipment that I decided to also buy as part of my "new life".

We have Medibank Private AdvantagePlus cover, which is a packaged hospital & extras cover, costing around $220 per month for family cover. It gives you full hospital cover, and also covers the full range of extras, but at slightly lower levels of cover for some procedures when compared against "Blue Ribbon" cover. Waiting periods vary from 3 to 12 months, with 12 months being the norm for most procedures.

The product allows us to earn a package bonus, up to a maximum of $1000. It accrues at about $200 per year, and can be spent on any medical or health related service or product, up to a maximum of $500 per person per policy year. I used it to cover the hospital excess ($200) and out-of-pocket expenses for the dietician ($300).

The hospital excess is something that we have elected to pay, in favour of a reduced monthly premium. It's capped per policy year, to $500 per person and $1,000 per policy (for family cover). The excess is $200 for the first and second hospital admissions, and $100 for the third, up to the cap level.

I don't work for Medibank Private, and am not endorsing their products or anything, I am just outlining how our cover works to try and help you understand how some of the health insurance products work in Australia. There are many other companies that offer health insurance, including some coprorate plans. However, as Medibank Private is part government owned, they are generally the best in terms of value for money.