Unfair gaps

[computerflyer]

Curiosity from someone with lots of crowns and who is anaesthetised to $1~2,000 a go. What costs $27,000? or even $7,500 as you did use the singular "tooth".

[justnikky]

Booking dental holiday to Phuket this year! Hubbies tooth quote here $27000!!!! Phuket $7500! I say....bring on the holiday soon. Cheaper than the gap we would have here.

Bought my glasses online, single vision, transition, rimless $95 no rebate, Instore $380 after Medibank rebate! Hubbies glasses $35 Online no rebate, Instore $285 after rebate! Didn't even bother claiming back my online purchases they were so cheap.

Breast reduction surgery here (medically neccesary) $7000 not including anaesthetic! My Medicare and Medibank rebate combined $785! Non medical breast enlargement gets a bigger rebate I might add!

I am cancelling our fund this month, buying glasses online, going on a hoilday and getting our teeth done and going public for emergencies. No more of this rip off for us!

Had enough!

[alinebiz]

Somebody mentioned it is a shame there aren't online dentists - that's true. But there is another option. You can get dental work done very cheaply in places like Thailand and Vietnam, apparently by dentists who have been trained in Western countries. The savings would pay for your holiday. Depends on what level of risk you are comfortable with.

[justnikki]

I was in hospital last week to have my gall bladder out (emergency)
Great.......I have private cover I thought.
Hospital was good, surgery went well.
Got home to a $910 Anaethesthetist bill, and $245 scan bill which both performed as an in patient. I called my fund to be told to call Medicare.
Refund of $230. I pay the rest?
WT? I have to pay for my anaesthetic! How is this right? You can have surgery but with no anaesthetic unless you want to pay big sums of money ?
Thats it! I am quitting my fund. Cheaper to pay 1% tax.I pay $76 per week to be slugged with bills after an essential surgery. Public hospital would have admitted me, performed surgery and sent me home for FREE!
Sick of this blatant rip off and illusion of health cover as long as you don't get sick.

[justnikki]

Well, been to dentist again. My child needed a filling. Bill $348. Refund $92.00 and I paid Gap again of $256. Yep.......private Top Cover is an absolute and complete rip off. Whats even funnier......I have pet insurance and my dog needed teeth done. Bill $600. My fund paid $500 and I paid a gap of $100. It costs me $40 per month for this cover and I feel it is ironic that my dog has better cover than my family .

[Betterworld]

MBF has member Dentists that have much smaller gaps because they pay them a higher rebate and the Dentist has to charge rate set by MBF. MBF can give you a list of no gap or very little gap dentists. If you quote your item numbers you can be pre warned what the gap will be. I'm happy with my local member dentist. She's great.
I've had a son having major dental in hospital with Paedatric Specialist last week. Bill huge! I've spoken to other dentists and specialists about the bill. They agreed with me that some items are suspicious. Eg. Preventitive fissure filling and stainless steel crown on same tooth. Incisal corner restoration and amalgam filling with resin crown on top. Most even thought the pulpotomy and extraction billed to one tooth was Not right. Of course he wanted 100% payment up front. I'm waiting to hear back from him.. My MBF covers $300 general and $800 major so through that pretty fast! Still over $3000 out of pocket. 3hrs work...nice hourly rate! Where your kids are concerned we are all just putty in their hands.
The anesthetic will be a big bill too. Quote was very large. Problem is Medicare sets what they think are reasonable rates and then pays 75% of that fee. My MBF then pays the other 25%. making 100% of a fee no one has charged for 20 years. That is why the gap is so ridiculous. That 100% = 25% of my child anesthetic true costs. Medicare needs to look at the costs again

[justnikki]

I agree! An online dentist, I suppose if you have dentures it may be possible (joke)
Seriously you do feel ripped off and shopping around.....well, they are all the same.
Westfund are cheaper for policies and offer better rebates only if you go to their one and only dental clinic in Lismore NSW lol.
Westfund told me dentists charge what they like and the health funds pay the allowable item number cost which falls way short.
Also, if you need surgey the anesthetist is not covered by medicare or health fund Why is that?
Not Good Enough!

[nutsdeb]

Same here... top hospital and top extras at $270 per month and you think that gives you more than $70 rebate on a $375 dentist bill (which, by the way was for one filling and a clean - and I told him where the filling is).

Shopping around sounds good in theory but not many dentists are taking new clients so you have to take what you can.

I have, however, found buying glasses online very, very cheap. Two pairs at Glasses Online for $159 and I got $129 back from my fund. Two pairs for $30 - bargain! I will try the same with contact lenses too next time... shame you can't go to an online dentist.

[justnikki]

Well, I got a quote from the childrens dentist today, they have to go to hospital for dental work. Great I thought, will ring through to Medibank for the info.
Bill is $2155 not including anaesthetist bill and Medibank Private refunds $707. So... There you go! Top level cover that pays out less than a third of the account. $70 per week for that! The kids teeth will have to wait until we can save the $1800 gap payment.
So...am cancelling and putting that $70 per week into a savings account for emergencies like this in the future.
That gives me over $3400 per year with interest.
Not happy

[justnikki]

Thanks for the tip. I have been looking for a better alternative and so far they are all the same. The premiums are all about the same for us ( family with kids on top level cover and the benefits and limits are all the same).
Dental and optical are the worst . A root canal for instance is $900 per root. 4 in a tooth so the cost is $2700. Your rebate is a tiny fraction of that not including the yearly limit. So the alternative is removal of the tooth. Again, the gap is ridiculous. Ok, you get free dental exam. Big deal At the exam they find holes and gum disease and advise that you need fillings and crowns and a root canal but hey, you have a limit and you then have to find the cash for the huge gap. So you get one thing done each year but by that time, the tooth has had it and out it comes.
It totally totally sux.
Go to hospital? Well ring around for quotes if you live in a big city. Us country folk are stuck with 1 hospital, 1 specialist and 1 anaethesthtist. So you pay what they ask. If we need serious hospital attention we are sent to the major Public hospitals by default anyway. A gap and the cost of anaesthethetic ( which is not claimable?). So really, you pay private cover for a carpeted room and an ensuite and thats about it really.
If you are allowed $250 per member for glasses per year, then why cant you use the entire limit on one pair of glasses instead of a percentage each time? Same with dental? Most people will go for dental fillings etc once per year anyway.
Members choice providers are cheaper but where we live, we are 400kms from the nearest provider so we have to use the local guys. So we pay a bigger gap. Discrimination on the basis of where you live.
Premiums and Insurance costs would decrease if gym fees, Jenny Craig and the like were not included. Just plain medical cover.
Very disillusioned with the whole thing . Many people where I live have cover and feel the same way.

[computerflyer]

Dyslexia...GMHBA

[computerflyer]

Shop around. I pay noticeably less per annum and have better reimbursements than you appear to. Quote from GMBHA for one.

[justnikki]

Just got back from the dentist for a filling. First dentist visit in 4 years. I have top cover that costs me $70 per week. I assumed that by paying top cover, then I would have just that....Top Cover. My bill was $289 and my gap was $229. Medibank paid $60!
Unbeleivable! You never know how much gap you will have from one visit to next. I needed anaesthetic for the bill shock!
Glasses.... well lets see, cost $395 I pay $260!First claim in 2 years.
I am fed up. I feel ripped off and I don't think members get their monies worth.
I think medical cover should be just that, no gym fees etc, just medical cover.
I want to go to dentist, hospital or optometrist and know up front what my gap is. Not be standing at the counter embarrassed because I underestimated the gap and not having enough in bank to cover it. Why can't health insurance be fairer and good value. No wonder people leave it and go public. Hubby severed his finger, had to go to hospital, had a $1500 out of pocket! If he went public, still fixed up just as fast for free. So why have it? $3408 per year and we save the 1% extra tax of $ 950? I am thinking its false economy.
This insurance is fine as long as you don't claim on it, in otherwords expensive and unfair.