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Australian Unity Health Insurance - not recommended

Discussion in 'Businesses and Service Providers' started by cuvy, Jan 25, 2010.

  1. I was hit by a car late last year, and i thought i should share my very negative experiences with Australian Unity Health Insurance.

    I've posted about it more here, but to summarise, if you're in a motor vehicle accident and with Australian Unity Health Insurance, without a big fight, you're basically without health insurance.

    Here's what happened.

    - I was hospitalised in September, and as is normal, on discharge i filled out a questionairre, which had a question asking if the admission was related to a motor vehicle accident. I ticked yes.
    - Several weeks later I received a letter from Australian Unity asking for details of the accident. I provided these, as well as contact details for the lawyers i've engaged for the injury claim.
    - i heard nothing else from Australian Unity
    - about a month later my lawyer received a letter from Australian Unity, which, when read by any reasonable person, basically said "we note that this is related to a motor vehicle accident. here are the accounts, we expect that these will be paid back if an injury claim is successful. both myself and my lawyer interpreted the letter in this way
    - in december, i received a call from the hospital asking why i had not paid the bill of $14.5k. Australian Unity had refused to pay them (saying it was a motor vehicle accident).
    - I had not received a refund of my hospital excess, nor any contact to say that they would not pay and i would need to pay
    - upon queries to australian unity and re-reading the letter they sent my lawyer, it became apparent that they refused to pay. The letter which they had sent was extremely vague and confusing, and only after having it explained could my lawyer or I work out this is what it meant.
    - Australian Unity were not helpful at all, and the hospital was at the point of selling off the debt to a debt collection agency if it was not paid in two days. my lawyer spent several days (at $400/hour, mind you) sorting this out. had i not had his assistance i probably would not have been able to sort this out
    - at the same time, i was being admitted to a second hospital for another lot of surgery related to the accident. since it was related to a motor vehicle accident, the hospital knew that australian unity would not pay, and hence required me to pay full fees ($8k estimate for surgery and one overnight stay) on admission, no exception.
    - had i had more time, then i could have gotten the irrevocable indemnity signed and avoided this. However, due to the nature trauma care, i didn't have this time.
    - a separate claim was later submitted to Australian Unity by my lawyer for surgeons fees. They were supposed to return these back to me for submission to medicare, however they failed to do so. Only upon multiple queries a few days before the due date revealed that they had not, and hence rather than paying a gap, i had to pay the full amount and claim back.

    So, to summarise the key points

    - australian unity took my hospital excess and refused to pay, with no real notification that they would not pay.
    - fund rules state that if i sign an irrevocable indemnity, they can provide insurance as normal. it took a real fight by my lawyer to find this out, and i would imagine that a lot of people would not find this out, and hence have no insurance.
    - their attitude seems to be "if someone else might be liable to pay, then we won't pay until you provide written evidence that they won't pay". Imagine if your car insurance was like this.
    - they stuffed up many claims, causing me much more financial hardship than i should have had.
    - from speaking to accounts people at two hospitals, it seems that Australian Unity is unique in their approach to these sorts of situations, and that no other insurance company is that difficult.

    The bottom line for me is that health insurance is there for when you need it most. In my experience, Australian Unity health insurance isn't.

  2. Interesting.

    I don't know how your 3rd party in-sewer-ants works in Brisbane but in Victoria, if you are involved in a crash then your private health insurance does not come into play. TAC pays for any costs incurred when you greet the bitumen with your body.

    After my crash and surgery, TAC paid for almost everything. I was out of pocket $116 for the MRI to determine the damage to my shoulder. Now I could have claimed it but meh..........

    Sucks to hear you got dicked around.
  3. That whole story is nothing short of farked. I too think/thought that health insurance is there if you need it. It looks more and more like that it is only there for them to take money from you. So if you suffered the same injuries from falling off a ladder they'd have simply paid up? I thought it would be similar to how it is with a car in that if there's funds to be recovered from elsewhere that they'll do it afterwards.

    I hope that AUH's stance doesn't start being taken up by others. It'll just mean it'll be more like the way we're told the US system is like - they check to see if you can pay first before anything else.

    I actually bothered to read my policy in full last year. They basically say that they will only cover what Medicare does. Where's the real difference in getting health insurance? I was under the impression that with health insurance that if you need surgery then you're more likely to get in a lot faster than through the public system. However, if your injuries require immediate care, you may as well go in as a public patient and save the excess and additional bills that health insurance (and Medicare) won't pay for. I've only got health insurance for the off chance I need something like a blown out knee fixed so that I won't have to wait as long.

    I really can't understand why we just don't put that money into the public system. Public hospitals treat private patients. Health insurance companies operate for a profit as do private hospitals. Public hospitals don't have that additional profit margin so if we put that money into the public system, we should have higher overall numbers of beds, surgeons and nurses. It all just doesn't make sense to me. I can only conclude that the scheme where the government will make you pay one way or the other if your income is above a minimum level is just set up to eventually pull out of public health altogether. Medibank is government owned and the biggest health insurer in Australia. It is also the most expensive in terms of premiums. Why would the government ever knock back the yearly increases the health insurance sector seek? In the last 5 years, my HealthSmart premium has gone from about $750 per year to about $1,100 for the same cover. That's not a bad increase for them is it? I wish my salary went up by the same percentage as that for the same job and level of responsibility. Medibank is being built up to be sold IMO.
  4. Such are the joys of private Health... I have Insurance but even now I'm not entirely sure what for...
  5. Based on what they explained to me after my off about 6 months ago, TAC does not automatically cover everything. They kick in at a particular point. It turned out that I suffered nothing more than heavy bruising to the back of my knee but if any issue arises in the future, the TAC told me that they'll start paying after I've hit $750 (I think - it was somewhere around this mark) in expenses and it would mean that I'd initially have to use my own health insurance. If I didn't fill it in as TAC when I went to hospital, Medicare would have covered that check up and I wouldn't have been obliged to fill out a police report but then I wouldn't have any potential future TAC coverage.

    Regardless of how much/little your out of pocket expenses could be, the TAC coverage is one huge plus Victorian motorists have over the other states.
  6. Vic -- whats the ACT/NSW status/equiv of TCA ?-- or point me to a thread that explains it - cheers
  7. Fault based compulsory third party (CTP). Essentially, if you plough into a tree you're up shit creek, but everyone else affected by it just claims off your policy. Quite curious as to the system up in QLD after reading this.
  8. Funnily enough, the car that hit me was victorian registered, and hence the TAC is the third party insurer. In cases where they are liable (this doesn't include single vehicle accidents), they act as any CTP insurer does - they usually agree to fund reasonable rehab costs, on the condition that if they are not 100% liable then you'll have to pay these back proportionately.

    In my case, i needed to have surgery with only a few days notice, which was not enough time for the TAC (or any CTP insurer) to agree to cover. I had thought that, since i had private health, that I would be covered, but as is usual for insurance, they'd want their money back if they could get it.

    Private health insurance is, in my opinion, worth having. The difference (unless you're with australian unity, anyway) is that you get to chose when/where/who does the surgery. In the case of my initial hospitalisation, had I not had private health insurance, I would have gotten the on-call orthopod, who knew very little about trauma, which would have meant an extra week in hospital (to wait for the swelling to go down before operating) and most likely worse long term outcomes.

    Thankfully, from talking to accounts people at two hospitals, it does seem like Australian Unity is unique in its approach to these matters. I will certainly be ditching them as soon as I can.

    Working for a public health provider, I can, unfortunately say it is a very complicated problem, and there is no simple solution. Blindly pouring extra money into the public health system is definitely not the answer. There are a lot of advantages to using the public health system (better nursing care, but multi-trauma care, more modern and well maintained equipment, etc) but there are also advantages to private health care (no waiting lists, your choice of surgeons, etc). I still think we are better off with both systems.

    Agreed - would make it a lot easier for those who have single vehicle accidents or hit and run type accidents.

  9. It is just the same as what you just described.
  10. Ah, cheers. Should've paid more attention to the OP and realised the insurance co was just a cockup.
  11. I dont have private cover atm, I'm considering it in the near future to get some 'upper torso' work done - but i'd be dumping it as soon as I was done.
  12. Holster, what would be the benefit in taking out a policy? There seems to be a couple of times per year where most of the health insurers offer no waiting periods as a condition of joining at that time. If you're not fussed about when you get on board, choose the 'no waiting period' time.

    In general, the cheaper the policy, the less the total potential benefits there are. I tinkered with the idea of leaving MBF then didn't bother once I saw why other providers were cheaper (less benefits or the maximum amount they'll cover is less). I could quite easily downgrade my policy to reduce the premium then it'd be about the same.
  13. Going to get a reduction? Those mammoth cans can't get any bigger :D
  14. There are benefits.

    When my wife was pregnant we had private cover. Chose the paediatrician, chose the hospital chose everything.

    All we needed to pay the hospital was the $100 out of pockets and the $117 that I had rung up in meals. They didn't charge me to stay there for a week.

    When The second kid was born she refused to breathe for the first minute or so, so she ended up in the Nursery where her O2 Sats. was monitored for 7 days.

    That hospital visit cost the same, $100 out of pockets and $117 for me.

    Both times we were in there a week.
    Both times it cost us less than $250
    The nursery stay is charged out at $700 a day. <--$4,900 that we didn't have to pay.

    We don't have it now. We probably should.
  15. The difference is about 10k - 15k

    That is how much extra I'd have to pay for what I want done without private cover.
  16. I was on Australian Unity for several years until I was in a similar situation where I was in an accident and they refused to pay my medical expenses. I ended up switching over to Real Insurance and I haven't had any problems since then. Check them out at http://RealInsurance.com.au.