Private health cover funding Australia

[Justin04]

To my Aussie pumpers, not a political person but the new budget is out and what I’m hearing is the private health funding will require us to be at top level cover (gold class) to be eligible for a pump from now on. This will mean significant extra cost than I am currently paying on my already expensive private health cover. Still no mention of subsidies for cgm though which I think is unfair. Not just me but the technology should be available to all type 1’s as far as I’m concerned. I have penned several emails to government members haven’t so much as received a reply in the last three months. Not really a help topic sorry guys but just sheer frustration at who they are helping in the “lucky country”!!!!

 

[kitedoc]

Hi @Justin04,
It is the Private Health Insurance companies helping themselves by changing the level criteria for pumps.
Never mind that those that use the private insurance spare the numbers queuing for the relatively paltry number of pumps
on the public scheme.

it is all very nice to get a 1/3 tax rebate on private insurance but costs keep rising!!!

The subsidy for pump consumables is helpful but why cannot the Govt deal direct with CGM manufacturers for a better price?

I am assuming the additional categories for subsidies for pump CGM's have been granted - now to include pensioners and diabetic women during pregnancy.
My DNE tells me the criteria for the CGMs is very stringent now.

And not a peek-a-boo about funding Libre (Flash) as a stand-alone CGM.

The only distant pale cloud on the horizon is that W.A. Govt went from Oz to visit the wizards in the UK about the low carb program for T2Ds. The one that the NHS reckons will save billions in UKP over the next decade.

If the Feds here could be persuaded to deal with the DAA (see Jennifer Elliott vs DAA) and medical authorities AND implement low carb program here - the savings could help a lot of people, not just diabetics.

Mind you the daft pollies are likely to siphon off money for something useless like extending Parliament House upward, or building a Trump Wall somewhere.

If there were enough pump users we could approach health insurance companies as a group and bargain the price down maybe.
A pipe dream without a very influential sponsor to assist us !!!
I reckon there will be more individual use of out-of-warranty pumps in the years to come.

At least we are not going to die from inability to afford insulin !!

 

[Justin04]

That’s right mate. I understand that private health companies are just jacking the price up to compensate for outlays but surely the government could step in and clamp them off. That was my main argument. I don’t really care who is in power, but support a disease that could save them lots of money in the long run. They did add pregnancy and pensioner into the mix. That’s great if you fit into those categories.
The other thing I wonder is for all the under 21’s that currently have access to cgm, when they age they lose the privilege. So for someone that’s had cgm since they were diagnosed 10 years ago (hypothetically) and all of a sudden have to do it the old fashioned way is just downright cruel not to mention dangerous.
I know me jumping up and down and throwing the toys out of the cot isn’t going to fix anything but middle age middle class people like myself just keep footing the bill and there would be quite a population here I would assume. Any way, my thought on sport, cheers for the vent ha ha.

 

[aphex2k]

I'm with Medibank (previously HBF)

Settled Families Comprehensive cover. Costs us $155 a month. So that's me, wife and 2 kids under 10. HBF previously paid for my Accuchek pump. Switch to Medibank paid for my 640g and transmitter. I have to fork out $250 a month for the sensors for the 640g CGM. Plus the usual, insulin costs. Test strips and cannula covered by NDSS. Insurance covers a heap of other stuff which has been useful. From help wtih cost of glasses, dental, physio work. It makes sense for me and the family. However my sister in law (single, no kids, and no long term medical issues) has just cancelled her insurance as she wasn't using it. When we all came over on temp visas it was mandatory that we all had full comp insurance.

I've just got new glasses which are multifocal, plus working for the govt I get a rebate as a display screen user, so paid very little actual cash for these new specs. I had to use physio a few sessions last year due to a back/shoulder injury. This insurance does come in useful for us.

I don't consider my level of cover to be Gold Standard but I know that finding an extra 200 bucks a month would be problematic for some. As I recall, there were quite a few lower cost options that did include insulin pumps so shop around mate. Play them off against each other. Tell them what you want, and what you want to pay, and if they can't or won't cover you, try another one.

My nurse said HBF, Medibank and BUPA were the easiest to work with from her point of view, and she's got many years experience. It was her suggestion to change from HBF to Medibank as HBF, despite a letter from a consultant citing clinical need and improved prognosis, wouldn't fund a new pump. Medibank were happy to, and quick to sort it out too. YMMV!

 

[Justin04]

Hey aphex2k. Yeah we are in private health cover for us and the kids. Bupa have been very good, my pump was covered last year when I began insulin pump therapy. We don’t use anything either at the moment except dental check ups, which I guess is good, but at the same time is money down the drain. All health funds from the first of April now have a tiered scheme I believe introducing gold, silver, bronze, basic levels of cover across all insurers. No more one offers this whole the other one doesn’t. To be eligible for a pump on the new scheme you must have gold class cover. Which from my enquiring will set our family back an extra $200 per month. That was my sour grapes, the fact I use next to nothing of my current level of cover, yet I’m going to have to raise the level to stay eligible for a replacement pump in another three years.
And yet middle aged pumpers still don’t have access to any cgm subsidies. An extra $200 a month for private health plus $250 a month for cgm out of your own pocket. Ain’t it the lucky country after all ha ha ha.

 

[aphex2k]

Tell me about it. I can't keep up with all the changes. Unfortunately I had.....an accident, and lost my pump (long story, there's a thread). Anyway I'm "renting" a pump from Medtronic which is costing me $180 a month. I'm still having to pay for all the other stuff but maybe a pump rental might be more cost effective in the long run that switching to "Gold" insurance? I don't know what pump you currently have, or if other manufacturers offer a similar scheme. I'm guessing you're a Medtronic user with a CGM subscription @ $250? I'm not entitled to a new pump / upgrade until the warranty period is up on the pump I lost, so essentially 3.5 years (boo!!!) but I'll be digging around for the best deals and if it means switching health provider again then so be it. I'm tempted with a 670g and closed loop but I'm also hearing some issues and problems so I'll ride it out and see what's on the market in three years. The optimist in me says "a cure!".

All the best mate.

 

[WitchettyGrub]

Hi Justine04. I don't have any answers unfortunately. May I piggy back your thread please?

I've just come back to Australia after 19 years. I keep hearing mixed messages about private vs public health care. I was always privately insured to the max, though never benefitted financially from it. Then my insurance overseas lapsed and I didn't notice. I had a mini-stroke and spent a week in hospital. Oops. Then I couldn't get insured. So now I have preconditions - mini stroke, diabetes 2 and 2 knees that will need 'replacements' at some stage. Some people in Australia are saying not to get private insurance. This scares me but the way the insurance is moving, I'm reluctant to make any sudden moves. I have no idea what to do. Any suggestions from Aussies? I'm 55.

 

[Mike d]

If you're now back "home" why not ask them? Waiting periods, coverage plans and costs vary considerably

Guarantee you this ... you're gonna be facing a long long wait for knee replacements on medicare

 

[Justin04]

Hey @aphex2 I remember reading that thread. That’s some terrible luck mate. I can’t believe it never got handed in. No good to anyone else really. Yeah I’m a 640g user, very happy with the pump but the fact it can do much more that isn’t affordable to me until we get some help. As I said earlier, it would benefit the health system in the long run. Mind you, my sugar is purring along at the moment thanks to the 640g. Thankfully I won’t have to worry about the levels of cover for another three years but then it’ll be a shop for the cheapest deal. Never know in three years the government may have pulled their finger out and begun subsidising the cgm. Now that’s optimism if I’ve ever seen it.
@WitchettyGrub we’ve had private health since my wife fell pregnant, never needed it but it was a good in case thing we thought. We’re primary producers so it’s amazing we’ve never needed it truthfully. Been some close calls!!!
With a pump I have no option but to keep it but even without a pump I’d still have it anyway I reckon. If I need glasses or the kids need braces or something it’s definitely going to help.