- November 2, 2023
- Posted by: legaleseblogger
- Category: Related News
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Heading: Financial Struggles and the Importance of Hospital Cover: How AI Legalese Decoder Can Help
Introduction:
Greetings,
I hope this message finds you well. Today, I would like to discuss a pressing matter concerning my finances and the need for Personal Health Insurance (PHI). Due to unforeseen circumstances, I find myself in a dire financial situation this month. This unfortunate turn of events is a direct result of the numerous tests and medical procedures I had to undergo. In an attempt to alleviate my financial burdens, I have been tirelessly researching different insurance providers. However, I am still unsure if investing in hospital cover would be a wise decision.
The Dilemma: Hospital Cover or Not?
One aspect I am firm on is the necessity of extras coverage, particularly dental care. While I have received mixed advice from friends and family regarding hospital cover, I remain perplexed. If I were to, hypothetically, break my arm, would PHI truly help minimize the financial strain? Or does Medicare provide sufficient support in such instances? I have noticed that many of the benefits offered by lower-tier insurance plans are not applicable to my personal circumstances. For example, I have already undergone wisdom teeth extraction, reside in Queensland (where ambulance cover is not required), and do not anticipate needing any abortion-related services. Consequently, are there any must-have benefits exclusive to higher tiers? Could the inclusion of bone cover, for instance, justify the additional weekly cost?
Unlikely Hospitalizations and the Burden of Excessive Costs:
To provide you with a comprehensive understanding of my situation, I must emphasize that I do not plan on having children nor do I have any pre-existing conditions that would warrant hospitalization. The primary factor contributing to my current financial strain is the cost of ultrasounds and appointments. Therefore, I am curious to know if extras coverage could potentially assist in shouldering these expenses, or would they be better covered under a hospital plan? It is worth mentioning that my scans were conducted at a radiology clinic, not within a hospital environment.
The Request for Advice:
I truly appreciate any guidance you can provide me with, as this is a matter of great importance to me. Moreover, while I have your attention, I would like to inquire about Personal Health Insurance providers that offer flexibility in choosing the specific extras one desires. Personally, I do not face any eye-related issues, but I do prioritize maintaining dental health.
The Role of AI Legalese Decoder:
In light of my financial predicament and the complexity of PHI policies, I would like to highlight the benefits of utilizing an AI Legalese Decoder. This innovative tool has the potential to simplify the daunting task of deciphering legal jargon, enabling individuals like myself to make informed decisions regarding insurance. By employing advanced algorithms, the AI Legalese Decoder can analyze policy documents, identify key details, and offer insightful explanations. This invaluable aid not only saves time but also ensures comprehensive comprehension.
Conclusion:
Thank you once again for considering my predicament and offering any advice you may have. Your expertise and guidance would greatly assist me in making an informed decision regarding hospital cover. Additionally, if you could provide any recommendations for Personal Health Insurance providers that offer customizable extras coverage, it would be immensely appreciated.
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AI Legalese Decoder: Simplifying Legal Jargon for Everyone
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FREE Legal Document translation
****** just grabbed a
ItÔÇÖs primary benefit is to avoid the 2% levy
Otherwise itÔÇÖs main benefit is you can typically get treatment faster, not cheaper
In an emergency, you will always receive free treatment at the nearest public hospital. People get PHI to avoid waitlists for non-urgent procedures.
With the extras – will you actually save any money having PHI? They have pretty low caps on things, and by the time you pay for the insurance, you might find you’re financially better off just paying out of pocket and getting the medicare rebate back.
PHI Extras Cover will not get you cover for radiology as an outpatient (not in hospital).
Yes to dental and physio, optometrist though.
Also: extras cover is rarely worth the outlay, even if you are attending for dental check ups every 6 months.
PHI is an insurance not an investment. It can give you better financial certainty for _if_ a health situation arises.
If you desire such certainty / peace of mind, it helps. If you are happy to take your own chances and if something happens wear the cost implications of the health situations, you can choose to do without.
A couple real life examples of what could happen.
– at the start of the year, there was no reason for me to think I would be using the hospital cover any time soon. But something was detected that I did not want to wait for an indeterminate duration. I have been in hospital twice so far, and our PHI covered at least $5k of the expenses. Ie relatively small financial benefits.
– some time back an elderly couple in our extended family stopped their PHI thinking that itÔÇÖs a waste because they did not get to use it. A couple years later the husband had a heart condition surfacing and wanted an elective heart surgery done ASAP instead of waiting for months / years living with a ticking time bomb. They ended up being about $100k out of pocket to have it done straight away. Ie very significant financial hit.
There is no right or wrong. It comes down to your own risk assessment / risk appetite for the unpredictable.
I have top cover of PHI, however did it too late and so I still pay the Medicare Levy. However, in the two years since IÔÇÖve upgraded to full coverage, I have had a 4 week stay in a private psychiatric facility, an 11 day stay in hospital and appendix removed that same stay, a hysteroscopy and D&C which diagnosed me with adenomyosis and 6 days inpatient 2 weeksÔÇÖ ago for a bowel obstruction. I had a colonoscopy and gastroscopy as an outpatient 3 days post discharge and have been diagnosed with CrohnÔÇÖs Disease. Had I not had private health I would have had to wait for both scopes. I was losing enormous amounts of blood every month from the adenomyosis, so being able to diagnose and have an IUD put in was a lifesaver. Even with the CrohnÔÇÖs I canÔÇÖt imagine having had to wait 6-12 months just for the scope, let-alone the biopsy and treatment plan. ItÔÇÖs extremely worth it to me. For the record, IÔÇÖm 33, and until I turned 30 had no health issues. IÔÇÖve had incredible care and my gynaecologist, gastroenterologist and psychiatrist have been lifesaving/changing.
Honestly the hospital cover is more valuable than the extras. If you don’t think you’ll use it then just choose a high excess option. The wait for elective surgery is minimal which PHI. I needed my tonsils out and I could pick when I wanted my op, with the first available time 2 weeks after my initial appointment. I could choose a time that had minimal impact on my work. In some areas public patients wait up to 2 years and can’t choose when their operation is. I used to work in trauma, public patients would get discharged home. Patients with decent PHI would get sent to private rehab facilities. Plus you avoid paying the levy.
Private cover saved my ass, not long ago I had a serious accident and without private cover I would have been waiting weeks to get the right specialist surgeon. With cover it was done in 2 days and using new tech that meant I did not need to have casts and had a far less likely chance of losing motion in my joints.
That being said if you don’t ever have a big accident, maybe you are fine?
PHI is an absolute rort at basic level coverage because it’s essentially govt mandated transfer of monies from the general population (and public healthcare system) to private corporations who don’t even provide sufficient cover when stuff hits the fan. This, I dare say, is one of the reasons why Medicare is so underfunded and underresourced in AU today.
The threshold for people to be obligated to pay MLS, given 0-zero adjustment for inflation/bracket creep over the several years is just 90K for a single adult. This basically puts most of the middle working class into this bucket who either pay MLS or get PHI. PHI being the obvious choice as people can claim some extras with expectations to skip the waiting periods only to end up paying thousands and thousands more by going through the private route of treatment.
PHI in AU doesn’t cover gap payments for outpatient services which, if you think about it, is fair given not everyone can afford PHI. Such gap coverage would only incentivise healthcare providers to jack up prices for people without coverage because health cover providers would have massive bargaining power to negotiate a lower gap payment for their members.
Private health is of most benefit for long hospital stays as it covers the hospital accommodation component and usually in a private room.
My dad was in hospital for two months following complications from a knee replacement. He paid $500- for the entire hospital stay.
I was in a psychiatric clinic for seven weeks and it cost me $750-.
My auntie had a knee replacement and then did in-patient rehab for three weeks. She paid $500-.
You get private health insurance for big ticket ÔÇÿelectiveÔÇÖ surgeries. Knee or hip replacements, and hernia repair being the most common examples
This is the huge blind spot in the public system.
Though the vendor is just time can be 5+ years though. ThatÔÇÖs a big deal if you canÔÇÖt walk or work and there is a complete cure available but your just on a wait list.
IMO mental health coverage is the biggest benefit of private health. As this is the only area where you have access to significant services are ONLY provided in private system.
I have overseas health cover as I donÔÇÖt qualify for Medicare. I had a MTB accident in September where I initially thought I just had a small fracture in my elbow. Three weeks after the accident my elbow randomly dislocated and it turns out I tore the ligament. IÔÇÖve just had surgery for it. It was non urgent since I could use the arm as long as I didnÔÇÖt straighten it (but until it was fixed couldnÔÇÖt put any weight on it or do any sort of sport besides running). If I qualified for Medicare and went through the public system I would have waited months, instead I waited weeks.
Also, for diagnosis I needed an MRI. When I called they said it would be four weeks till the next appointment. When they realised I didnÔÇÖt have Medicare and would be going private they had an appointment that same day.
If you are a relatively young person with no major health problems… Are career building and on a career path etc
The benefit of PHI is being able to get anything fixed quickly. Because you can’t afford to be off work for long.
For example. You play sport on weekend. You bugger your knee. Do ligaments. You need surgery… You can’t walk. You can’t do your job without walking or standing.
In public system? You most probably wait months. What’s going to happen to your work? What money are you going to live on? You’re stuffed.
But private? You might get surgery within the week. Need only a few more weeks off and you’re back at work.
That’s the value of PHI.
Public is great for major illnesses & trauma. But for the things where you aren’t dying, just incapacitated? Public will mean you wait… and wait… and wait
Depends if you pay the Medicare levy, my private health is cheaper..
It depends.
In the past two years IÔÇÖve had two surgeries.
One was elective. Medicare would not have assisted. PHI kicked in a good chunk. Saved me literally thousands OOP.
The other was not elective. I could have had it done publicly but IÔÇÖd have had to wait longer. By going into a public hospital as a private patient I was given some priority (not absolute but ahead of everyone else at my same level of urgency) and I was guaranteed to get the specialist surgeon over whatever registrar. And itÔÇÖs nice to know you have the specialist (though IÔÇÖm sure the registrars are very good).
I donÔÇÖt think anyone should be supporting private health in this country. ThatÔÇÖs how you end up like the USA
Private health is mostly a scam. Stay away.
Based on your questions, you are new to all of this.
There are dozens of different ways that it costs more than you would expect , for below average service, and you only find out later, once you are stuck with these sunk costs.
I only have it for my partner and child. I can’t get it due to my age now
Yes for the tax savings and yes for significantly cutting down wait times for certain operations which can have an impact out outcomes.
I learnt the lesson last year, dropped private thinking IÔÇÖm young and healthy shouldnÔÇÖt need it. Ruptured my bicep off and had to wait 11 days to get it reattached in the public system due to priority orthopedic emergencies.
Bicep retracted / shortened further in that time making it difficult to access and reattach, meaning a longer recovery period and greater precautions post surgery.
From a doctor pov, it depends on the hospital/specialty. Ask your GP where would be good to be an inpatient and where wouldn’t. Some hospitals are good for end of life care and not much else. Some are amazing with an ICU. Some will get you awesome oncology or cardiology. The GPs know, because they send patients towards the good ones.
If you break an arm,Medicare will be all you need. Hopefully you don’t have to wait 8 hours for your arm to be set.
If you have a hernia, be prepared to wait many years to see a specialist and then wait longer for the surgery. With phi, you might see a surgeon and get the hernia fixed in a couple of months.
If you have a shoulder problem, Medicare will get it set but you will wait if you need further procedures.
Dental is hardly a reason to have extras cover. You are limited in how much you can claim and you will have large our of pocket expenses.
PHI policies have 3 levels of cover. Gold, Silver and Bronze. If you or your family do not need pregnancy cover and certain eye procedures, you should probably look at a silver or bronze policy. Make sure you are aware what each policy covers.
If you are forced to go private for elective surgery then phi is looking like a good idea
Private surgery can be quite expensive
PHI doesn’t cover testing. It only covers the private hospital bed.
When you use a private surgeon medicare will pay 75% of the scheduled fee and your PHI will pay 25% of the scheduled fee. No private surgeon I have met only charges the scheduled fee. The out of pocket costs range from $500-$4,000 for what I’ve had.
100% worth it. You won’t know how much you need it until you actually do. I know that sounds Zen but it’s based on my experience.