If you have private health insurance, there are some simple ways of making sure you’re fully informed before you go to hospital for surgery or a procedure.
Private health insurance is about giving you choice – your choice of doctor, your choice of hospital, your choice of timing. If you’ve been referred to a specialist for potential hospital treatment, it’s a good idea to plan ahead with a list of questions to take into the consultation..
As the Choosing Wisely website explains, these 5 questions should be top of your list when speaking with your doctor prior to your procedure. These will help you have the key information you need to make sure you’re as prepared as possible.
1. Do I really need this test, treatment or procedure?
Tests are an effective way to help you and your doctor or health care provider determine the problem. Equally, treatments and procedures may help to treat it. If you are unsure ask your doctor for greater details on why they feel this test or procedure is necessary for you. Find out how effective this procedure is, and how long the benefits usually last.
2. What are the risks?
Every surgery brings some risk of complications, so you need to understand how common they are. Ask your doctor if there will be any side effects to the treatment or if the test has a risk of providing you with results that aren’t accurate. Understanding whether this could lead to more testing, additional treatments or another procedure is important. Your GP may be able to discuss these with you, but the specialist will have the most information.
3. Are there simpler, safer options available?
Perhaps there are alternative options to the proposed treatment that might work. This could include making some lifestyle changes. Eating healthier foods or exercising more, can be safe and effective options.
4. What happens if I delay my treatment?
Ask if your condition may worsen — or improve — if you don’t do anything immediately.
5. How much will this cost?
Get a detailed breakdown of fees at the initial consultation with the specialist to avoid any unexpected out-of-pocket expenses. There can be a wide range between what specialists charge, but paying more doesn’t necessarily mean you’ll get better quality care. Ask about the fees that each health professional in the team will charge, such as the anaesthetist or an assistant surgeon. This is known as Informed Financial Consent.
Contact Medibank to discuss if you can be referred to a specialist that participates in schemes such as Medibank’s GapCover, which can help to reduce out-of-pocket expenses.
GapCover may not cover all of your medical services. Specialists can choose whether to participate in GapCover for part, or all of your treatment, so check with your specialist to see if they will participate. And remember, there may be other charges aside from your specialist’s fees that can add to your total costs.*
* GapCover does not apply to diagnostic services. Excludes public hospital covers and overseas visitor covers. Out-of-pocket expenses may still apply.
Other questions worth asking
Now that you’ve got the answers to the most crucial questions, here’s a few more worth asking your GP, specialist and Medibank.
Questions for your GP
Why are you recommending this specialist to me?
If your GP recommends a particular specialist, ask them why they’ve recommended them over others. If you know which specialist you would like to see, you can ask your GP to write a referral to them. You can also ask for an open referral – this provides you with the choice on where you present the referral or which specialist you want to visit.
Find the specialists who participate in the Medibank’s GapCover through the Medibank Find a Health Care Provider or call us on 132 331.
Questions for your specialist
Will my current lifestyle and health impact possible treatment?
Be honest with your GP and specialist. Discuss whether you have any risk factors, such as obesity, smoking or diabetes, which might increase the chance of side effects or complications.
What experience do you have with this procedure?
Take some notes when you visit the specialist so it’s easier to remember what you discussed, especially if you’re seeing another doctor for a second opinion. You may like to ask: how many times have you performed this surgery? How regularly do you do it now? What is your complication rate?
Will I need to stay in hospital and what will my recovery be like?
Ask the specialist how long you may need to stay in hospital, what are the best available hospitals for your circumstances, and how long you’ll need off work. Ask what rehabilitation or follow-up is required, or if you’ll have restricted mobility in the weeks or months after surgery.
Questions for Medibank
What does my private health insurance cover?
Call us on 132 331 to find out if this procedure is included in your cover, and ask your specialist if they charge any additional out-of-pocket costs. Refer to your member guide or the Going to Hospital Guide to see what your policy covers.
How can my private health insurer help me post-procedure?
Medibank can assist eligible members to recover from surgery with support ranging from free transport assistance to mobility aids for the home through our Health Concierge program. If you’re having a knee or hip replacement you may eligible for rehab in your home. Give us a call to discuss your options before you go into hospital.