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Thread: Anybody Got Any Experience with Private Health Cover Claims?

  1. #1
    Join Date
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    Default Anybody Got Any Experience with Private Health Cover Claims?

    Son is scheduled to be operated on at end of this month. Just received literature from Medibank that I have to fill out pre-existing ailment form due to fact I have not held this level of hospital cover for over 12 months.

    First tey told me I didn't need to do that, just fill out accident report as it was a sporting injury. Now I'm supposed to do the other one. Apparently I was supposed to take son to TWO doctors, not one. WTF would I do that???

    Hmmm, anybody dealt with this before?
    Last edited by Devil's Advocate; 05-10-2010 at 12:32 PM.
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  2. #2
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    Nope, I used mine for an op, but waited out my 12 months first. I've never tried to use it for a pre existing ailment before my allotted time. Good luck.
    Mummies little 12 years in the making..... and Daddies little ratbag!!
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  3. #3
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    Hi DA

    I saw two doctors, actually lots of doctors but only my GP and my surgeon needed the health cover details and the hospital wanted them. And for the op there were at least three doctors, the anaethetist which you (or your son) should meet a few hours before the op, the specalist and the assistant doctor (or aprentice specialist). So that makes four doctors minimum.

    If you're not sure about the paperwork, ask your GP or specialsit for help. They deal with this crap every day. If you do need a second doctor opinion, your GP would need to organise it anyway.

    I didn't see much of it. I filled out the forms as best I could. I didn't mention the sports association might cover it cos that would just make life hard and they didn't ask directly. And I never saw any bills or gap fees - but that would have more to do with my dad being of that profession than anything most people would have to deal with.

  4. #4
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    Thanks GG, but I understood pre-existing to mean just that - pre-existing. Apparently any injury, accident that occurs at any stage within 12 months after joining is rferred to as PE which they reckon is standard policy.

    So far they've been good as the date of the injury was easy to prove, but it's the fact we were supposed to see TWO doctors that has made things difficult. In sport here, son was at a level where anything happened, he would just go straight to a specialist/surgeon without any referral needed, as they all know the Institute of Sport down here. They speak, surgeons will see, simple as that. That could be our downfall in the end.
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  5. #5
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    Quote Originally Posted by Hyacinth View Post
    Hi DA

    I saw two doctors, actually lots of doctors but only my GP and my surgeon needed the health cover details and the hospital wanted them. And for the op there were at least three doctors, the anaethetist which you (or your son) should meet a few hours before the op, the specalist and the assistant doctor (or aprentice specialist). So that makes four doctors minimum.

    If you're not sure about the paperwork, ask your GP or specialsit for help. They deal with this crap every day. If you do need a second doctor opinion, your GP would need to organise it anyway.

    I didn't see much of it. I filled out the forms as best I could. I didn't mention the sports association might cover it cos that would just make life hard and they didn't ask directly. And I never saw any bills or gap fees - but that would have more to do with my dad being of that profession than anything most people would have to deal with.
    Thanks for that understanding Hy. Please see above, that is our problem. We didn't need to go to GP's. Top sports therapists and surgeons and all those medical practitioners here will see sports players immediately without any referral.

    For my son, when the surgeon asked on phone who referred him, I told him the coach's name and it was like "oh, right, yeah, just bring him on in Mrs ....."

    Grrr. They have explained in this case they may waiver the usual requirement for two doctors to have seen him when injury occurred...not holding my breath.
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  6. #6
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    In that case - talk to the specialist and ask them to sort it for you. They must deal with insurance companies all the time, know how to get it sorted. Otherwise they're not going to get paid.

    PS I thought it was a medicare (fed govt) requirement that specialists were only seen after a referral from another doctor (GP). Cuts down on costs that way. So they (your sports person and specialists) will have a system that works around or with that.

  7. #7
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    Thanks, will contact him tomorrow. That's what medibank Private are trying to waiver, the need for the GP first prior to the surgeon we went directly to. They said under the crcumstances a waiver of the twop doctor rule could be in order, so will just wiat and see what they come back with tomorrow.
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  8. #8
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    Update - just received the phone call from insurance company. It has been proven this was not a pre-existing ailment, so have been informed to throw out all the paperwork.

    Claim completed and approved. Operation going ahead next Friday.

    I am SOOOOOOOOOOOOOOO relieved!!!

    *DA not too happy about getting up at 4am but hey, who's complaining*
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  9. #9
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    Great stuff DA! Hope all goes well for Son and that your patience stays intact while he is recovering!

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  10. #10
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    Lol Von, true!

    Can't move his arm for the first four weeks. What fun. Lucky the kid is practically ambidexterous.
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