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Feeling Ostomistic
Sunday, April 12 2015

 

NB: This is a sponsored post

When I was 19 and was newly wed (literally a month before) I had my first consult with my colorectal specialist as I had just been diagnosed with Familial Adenomatous Polyposis (FAP for short). FAP is a rare inherited disorder which occurs because of a mutation of the APC gene. For those (like myself) that aren't experts on human anatomy and physiology, the APC gene (Adenomatous Polyposis Coli gene) which is known as a tumour suppression gene, is responsible for suppressing tumours in the colon and digestive tracts. So when you have a mutation of this gene, it in turn significantly increases your risk of not only colorectal cancers but other cancers too.

I only found out I had this disease as my dad had been diagnosed with terminal bowel cancer which was caused from the FAP.

So it was in this initial consult with my amazing colorectal surgeon that he asked me if I had Private Health Insurance, and when I replied that I didn't he said to me "First thing to do when you leave here is to get yourself covered. You're going to need it in the years ahead".

So I left his office and started researching different providers and the main thing I was looking for in my cover (at the time) was to be covered for colonoscopies and gastroscopies and also to find which one I had the shortest wait on to claim for a pre-existing condition, which was 12 months (some are 18-24 months).

I became overwhelmed with my research and really wished I had of gone through a company that specialises in health insurance comparisons, such as Health Insurance Comparison, as it would have made things so much easier. Instead, I went old school and called every provider that came highly recommended or I had heard good things about. I ended up going with NIB, as they were the best fit for me and my situation and have had my cover with them for 5 years now (but still good to compare what all the providers can offer you).

There are different levels of cover to suit each individual's health and situation which fall under Hospital and/or Extras. Hospital cover, refers to the cover needed for hospital admissions or proceedures (there are some exclusions which you will need to find out before getting a policy, for example I am not covered for pregnancy or IVF related, but covered for most proceedures). Extras cover, refers to things that aren't covered by Medicare and includes things like optical, dental, chiro, physio, psycology, weight loss programs and some non PBS medications (there are more inclusions depending on the level of cover you need).

One thing that I didn't realise before I was 19, was just how beneficial having health insurance could be. I always thought that if I had just a medicare card that it was enough and to be honest I thought it was an expense I didn't need.

"But once I got the Private Health Insurance cover and have had it now for 5 years, I have learnt just how wrong I was when I thought I didn't need it!"

Here are 12 ways that having Private Health Insurance (PHI) has benefited me over the last 5 years..

#1: I get to choose who my treating Doctor is.... 
When you are sick and have become familiar with a Doctor or Surgeon and have built up a relationship of trust with them, it is a no brainer that you would want them to do your operation/proceedure or to treat you. When you are admitted into a Public Hospital as a Private Patient, you can choose who your doctor will be for the duration of your care.

#2: By using my PHI in a Public Hospital, I am actually helping the hospital! 
Each Public Hospital has medicare funding, and when a patient is admitted to the hospital as a medicare (public) patient all the costs associated with their stay e.g. blood tests, doctor consults, theatre fees, medications, accomodation etc is all charged to the medicare allocated funding of that hospital. So when I am admitted as a Private Patient in a Public hospital, the hospital is paid more and directly from the health fund, meaning that when I have scans or need to stay overnight the money goes directly to the hospital and can help them to provide more services to patients. I have had public hospitals send me a letter of thanks before to show their appreciation of me using my PHI in their hospital. If it means I can help others, I am all for it!

n.b: when you are admitted as a Private Patient in a Public hospital, usually you don't need to pay any out of pocket expenses such as your excess, but it is always important to double check with your hospital and policy provider.

#3: In a Public Hospital, you will get some great freebies if you use your PHI!
Have you ever had to stay in hospital for a number of days (or weeks) and have realised just how expensive it can be to hire out the tv? I think some hospitals charge between $6-$9 a day. So if you're in there for 5 days (for argument's sake) you could be looking at spending between $30-$45 JUST ON THE TV HIRE! I don't know about you, but I would much rather have the spare cash to get a drink or magazine from the gift shop. BUT if you use your PHI in a Public Hospital not only will you receive the TV hire for FREE, but you'll also get a FREE daily paper saving you up to $2 a day! C'mon who doesn't love a FREEBIE?

#4: You can sometimes get your own room.
In a Public Hospital the private/single rooms are pretty scarce and are given to patients on a clinical needs basis (whether public or private) but when there are patients who aren't requiring a single room, you can request to have your own private room (subject to availability) and is something you can discuss with the hospital. I don't always get my own single room, but sometimes I do for a couple of days, which is nice to just have some privacy and peace. This is different to the room settings of a Private Hospital, which most times I have stayed in the Private Hospital I have had my own private room with ensuite.

#5: When you need a surgery, you don't have to worry about long Public wait lists.
There have been times where for this reason, having PHI has saved my life. I am not saying that to be melo dramatic by any means, it is the truth. When I have gone to see my specialist and they have realised that I need to have a proceedure done quickly, they have booked me into the private hospitals on the next theatre lists. Examples of times have been:
a) I was experiencing really bad pains in my abdomen and pelvic area for months and when I got in to see a specialist he had me booked into theatre the following week to investigate what was wrong. I had a hysteroscopy, laporoscopy & cystoscopy and was diagnosed with stage IV Endometriosis. I had a 15cm round mass removed off of my left ovary with the lining of said ovary removed, a couple of 7cm masses removed from my uterus and hundreds of 1 & 2cm sites removed from elsewhere in my pelvic and vaginal area. My surgeon said it was one of the most extensive and worst cases he has seen in his career and for someone who was only 21, and to help me recover put me in a medically induced menopause for 6 months. I would have been waiting A LONG TIME on the public system to be seen, and who know's how much worse I could have been!
b) I was experiencing a lot of rectal bleeding and pain, and trying to eat food was not only an unpleasant and painful experience, but was resulting in really bad case of 'the runs' and there were times I felt I might not make it to a toilet. I saw my colorectal surgeon, who booked in for a colonoscopy that week at the Private Hospital and it was discovered that the polyps in my bowel had grown bigger and were starting to turn into cancer. So thankfully I had my bowel removed a couple of months later before it had time to fully turn into cancer and cause trouble.
c) Recently, I was diagnosed with Papiliary Thyroid Cancer and saw a specialist down at Sydney who is going to remove my thyroid (in a couple of weeks) and thankfully I had PHI insurance as the earliest he could do it on the public lists at the public hospital was August and that is still 4 months away! Instead, I am going to a new cancer hospital in sydney and I had control over where I had my surgery, what specialists and when I had it.

#6: You can sometimes get your glasses for FREE*
If you need glasses and can't afford the $400+ (or if you are saving for that holiday but need glasses and its an expense you don't want to part with), check with your Private Health Insrance extras cover as you may be entitled to a FREE or discounted pair of glasses. I get my glasses from Specsavers and sometimes they have a 2 for $199 special offer and have partnerships with different health funds that you can be entitled for the glasses for FREE or discounted and sometimes with no gap to pay either! Seriously, if optical is something you need it is something worth looking into as it can save you money! IMPORTANT: Check with your PHI first on what entitlements or extras cover you have before you purchase your glasses. They can also advise you on how you can claim your glasses under your cover.
*When I say FREE, some policies entitle you to claim all or most of your costs back to the PHI, check with your policy and provider.

#7: Speaking of extra's cover, how painful is a trip to the dentist on your wallet?
Just like optical extras cover, dental cover can help you save money too! It is important to speak with your insurance provider about what dental cover you are entitled to and how to claim before you get your tooth pulled so you know what to expect with any gap or out of pocket expenses.

#8: A ride in the Ambulance can become rather costly, but if you have PHI it can be FREE to you.
If you have PHI, your bill will be directly sent to your provider and depending on your policy and cover you might not have to pay anything additional. I remember once my sister had an epileptic seizure and my parents got sent a $900 bill. You never know when you might need it, but it is always best to make sure you have the cover there.

#9: Staying in a Private Hospital can be quite expensive if you aren't covered.
I was so shocked when I received a letter to show what was paid to the Private Hospital for a 3 week stay (was in excess of $21k) and thankfully was all covered by my policy. Except the excess of $250, which I have to pay twice a calendar year, my admissions don't cost me any extra and the level of comfort and care is really top notch. Don't get me started on the FOOD!! My first night I stayed there as a part of my 3 week stay (when I had my total colectomy), I had Roast Duck for dinner! Seriously something you would pay $40+ at a high end restaurant. Even the breakfast was gourmet! And I love having colonoscopies just so I can have their sandwiches (if only they sold them to the public I would eat there all the time), yes I have an obsession with their sandwiches, but when you have them you will understand just how good they are. Oh and did I mention FREE WIFI and FOXTEL in your rooms too, as well as private rooms with own little balcony (well the Private Hospitals I have been to have had WIFI and FOXTEL). It really is a great environment to recover in.

#10: Sometimes we need a little EXTRA help...
If you are needing additional services like psycology, braces (orthodontics) or speech therapy, these can sometimes be covered under your extra's package and can be claimable up to 75% back for some funds. These aren't the only extra's that you can be covered for there is a whole list of additional (and rather costly services) that you can claim back on. This is another way that you can save by having PHI. Always best to consult with your provider on your cover etc.

#11: You could be paying LESS in Taxes!
If you earn over a certain threshold and don't have PHI the Government may charge you more in taxes. There are also incentives given by the government to try and get more Australian's using PHI and offers rebates which are organised through your tax return. You will receive a financial statement at the end of the financial year ready to do your tax return.

#12: If you take your policy out before you turn 30, you'll avoid paying the LIFETIME LOADING FEE!
To try and incentivise more people taking out PHI earlier on in life (before you are 30), the Government has introduced a Lifetime Loading Fee which is a 2% additional fee applied for every year you are over 30 when you take out your cover. As explained on PrivateHealth.Gov, if you are 40 when you take out your PHI policy, you will pay 20% more than someone your age who took out their policy before they turned 30. The maximum loading is 70% and if you hold your policy for 10 continuous years it will be removed. The Lifetime loading fee will be calculated when you enquire about a policy, but best to do it before you turn 30 so you save in the long run! As I was 19 when I took out my cover, I don't need to worry. However my husband didn't take out a cover until after he was 31, so this applies to him.

My advice to you....
If you are chronically sick, or if you know in your future you will be needing operations, proceedures (like colonoscopies etc) or if you would benefit from claiming back on extra's such as optical, dental, chiro etc it would be best to look into how having PHI could actually be helping you in the long run. I know being sick is expensive, and there are some expenses we just can't avoid but I know I owe my life to having Private Health Insurance and I am so glad that I have it. I pay my premium fortnightly which is direct debited from my account (also get discounts applied for direct debit payments. But honestly, it is best to shop around and speak to the different providers about how they can help you and your health needs or speak to a comparison provider like Health Insurance Comparison who can help guide you to finding the right policy.

Thanks to Health Insurance Comparison, you could win a year's worth of PHI! Click the ad below to find out more!

I hope that this is a helpful guide into how beneficial having PHI is for me, and I hope this helps you to know a bit more about how it can help you too!

DISCLAIMER: While this post was written by myself about my experience in how beneficial PHI is to me and all views expressed in this article are mine, this post is not affiliated with specsavers or NIB but was written for Health Insurance Comparison.


 

 
Posted by: Talya AT 07:37 am   |  Permalink   |  Email


~  Living with Familial Adenomatous Polyposis - Effects of FAP  ~

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Talya Goding - Feeling Ostomistic   talya@feelingostomistic.com.au  |  0447 426 860

Thank you for stopping by Feeling Ostomistic. It has taken a lot of courage to share my story and I ask that you show me and my site/blog respect and courtesy. Views expressed in this blog are my own and I am not a nurse or a doctor. If you need medical advice please seek your medical practitioner.

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