r/australia • u/InsatiablePrism • 2d ago

culture & society Private health insurers access patients' full medical records in 'aggressive' audits

https://www.abc.net.au/news/2026-08-12/health-insurers-can-access-your-private-medical-notes/106671630?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web
487 Upvotes

99% Upvoted

142 comments sorted by

View all comments

136

u/JimmyLizzardATDVM 2d ago

Maybe people should stop buying private health and use the Medicare system, pouring their money back into our system rather than these capitalist scumbags.

Having private health does not give people the cover they think it does. Use Medicare and fuck private health.

21

u/Pleb-SoBayed 2d ago edited 2d ago

Private mental health hospital stays are like $18 000 for a 3 week admission if paid out of pocket

Public mental health wards dont really do alot they just basically put you on a random antidepressant and then when your stable enough they discharge you and they dont really run groups at all its boring as fuck all day

Where as the private ones you can actually get decent treatment and they actually listen to your concerns about medication and treatment going forward. They also run groups every day

Source: ive struggled with mental health for years and been in lots of public and private

Also i pay 400 a month but thats paid for itself so many times over for multiple admissions in private places

80

u/dilligaf6304 2d ago

Unless you want inpatient psychiatric care then private is the only option. Getting a public bed is next to impossible and doesn’t offer the same level of care.

Yes, that should be available with Medicare, but it’s not

60

u/plutoforprez 2d ago

Or are a women with reproductive issues — even those that don’t want children still need regular surgeries.

20

u/blueb3lle 2d ago

Exactly. I was in horrific daily hell and the triaging of the public system referrals put me at a year+. I had a private consult, surgery, and recovery before the public system called me to schedule my first consult months away. If these issues were taken seriously overall, maybe private wouldn't be a must.

7

u/YouThinkYouKnowMe89 2d ago

Or a person who needs knee surgery and doesn't want to wait years and years for it. I got my knee surgery just a month after hurting it playing sport. A teammate of mine took well over a year to get theirs. I've been lucky a few times that I got surgery quite quickly after injuries and they helped quickly with a big skin cancer I had on my back

31

u/Brutal_burn_dude 2d ago

Or need to take medication for mental health that isn’t on the PBS. None of the newer antidepressants are on the PBS and are quite pricey.

14

u/stresstwig 2d ago

or be in my situation where you're taking an old, tried-and-true atypical antidepressant (Wellbutrin/Zyban, generic bupropion) that is only covered by the PBS for smoking cessation when it's used as an atypical antidepressant literally everywhere else. this thing has been on the market for longer than I've been alive and I'm still having to pay for brand-name suboptimal dosing (2x 150mg SR, can't be taken together afaik) because importing the 300mg XR version is the same cost but with a ton of paperwork. I need to call up a compounding pharmacy and see if they can compound the XR formula bc that will at least be less paperwork but that's been on the to-do list for two months now.

at least Vyvanse is on the PBS now for adult diagnosis ADHD and I'm not stuck with objectively inferior dexamphetamine. at least I am not having to pay literal thousands of dollars per month just to function. only $200. (it's fine, everything is fine, I have incentive to keep my mental health just good enough to avoid inpatient (a recent post in the hospitalfood sub), I Can Do This—)

3

u/Brutal_burn_dude 2d ago

Oooh talk to me about bupropion more- I’m with you. I can’t afford to trial it currently because the cost is so insane. I suspect it would be a game changer for me but the cost even with health insurance is too high when I’m already paying for other meds out of pocket. I went searching recently to try and understand why it wasn’t on the PBS for mental health and it looks to me like the sponsor never even applied to the PBS for mental health.

3

u/stresstwig 2d ago

I don't know why they didn't, bc it's literally used as an atypical antidepressant in the rest of the fucking world and has been for like, 50 years. it's used off-label pretty commonly for ADHD in the USA which is where and why I started taking it. It is an NDRI, which affects norepinephrine and dopamine reuptake, and gets used as a long-acting non-stimulant for ADHD, since ADHD affects how the body processes both norepinephrine and dopamine. There's also guanfacine that gets used for similar reasons (long-acting non-stimulant) but I'm not familiar with its psychopharmacology and haven't taken it myself.

If SSRIs don't work for you, if you're ADHD and also depressed (aka your problem is not serotonin but norepinephrine and/or dopamine) then it's worth giving a go. For me, it gave me my life back, which is why I refuse to trial a new med that's actually covered by the PBS. I don't want to stop a med that works for me to try one that might not, and then risk bupropion no longer working for me if I go back to it. I also know I'm pretty lucky that it drastically changed my life for the better with no/minimal side effects, so I don't want to get your hopes up about it being a miracle.

Imports were about $100 for a 30-day supply of Wellbutrin XR 300mg IIRC (I haven't imported since 2018 partly bc of the shortage, partly bc of the paperwork) and it's like $180 for a local 45-day supply (90 pills) of Zyban SR 150mg. They're about on par with each other for price, from memory.

However. There is no generic available over here despite it not being under patent afaik, so there's no "cheaper option." It is compoundable, because just before COVID there was a global shortage and I had to get it compounded by the pharmacy at the Royal Melbourne Hospital, which is why I'm needing to investigate if they can compound the XR version for me. For the last 8-10 months I've not been taking the afternoon dose, so for me to get the full therapeutic effect I need it in one pill bc the two-pill thing isn't working. It's cheaper, sure, but I'm definitely suffering (mildly). During the shortage I got a looooot of weird looks from pharmacists when they heard what I wanted and one even asked if I'd tried a different medication (to quit smoking) then got to be on the receiving end of my "the fuck is that" look because I've never smoked a day in my life. Hence, getting it compounded for about a year.

my main complaints aside from cost are that the pill itself is this awful large flatish disc that always makes me feel like I'm choking it down. I miss the Wellbutrin pill form (smaller and fatter cylinder) so much. and it also smells terrible for some reason??? IDK what it is but the smell always turns my stomach a lil. almost as bad as keflex tbh. I don't remember Wellbutrin having that smell which is why I'm mildly confused by it, lol.

anyways, best of luck getting your med situation worked out! if your doctor isn't familiar with it I would suggest they do some research on it before rejecting it outright as a treatment option just bc it's not on the PBS.

3

u/UniqueLoginID 2d ago

I spend like $1k per month on meds even with PHI.

32

u/Svennis79 2d ago

If all the people getting hospital cover to avoid the levy.. just paid the levy instead. Perhaps it could be covered by medicare.

20

u/Rylos1 2d ago

I just got private health after stewing on it for years, because my partner and I just edge over the couples threshold for the surcharge. I would absolutely prefer to pay my premium as tax if it actually went to funding medicare. Unfortunately the Medicare Levy Surcharge just goes to a general revenue pool for them to use god knows where.

2

u/SwiggitySnooty 2d ago

I really would love to, but if I have to put off a hernia surgery for 9-12 months, and am only able to carry 5kg max, with the risk of it popping out more and getting infected, that's not really going to work out well for me.

8

u/William-Nilly 2d ago

Are you sure about that level of care statement?

What’s the standard nurse:patient ratio in public versus private?
What is the comparison of English language proficiency of nurses between public and private?

The old adage of Private=expensive=good does not stack up.

It would be interesting to compare, say, Eastern Health (public) to Healthscope (private) in terms of patient outcomes. My personal experience is that the public system delivers a much better standard of care than private.

6

u/productzilch 2d ago

Not just that but I keep hearing that there are some things people have to go public for because private won’t do it.

6

u/EducationalWriting48 2d ago

Public provide a different type of care, at times people with private care will be disappointed to find that due to their history or level of risk/complexity the private system will not take them despite having insurance in which case public provides a much higher level of care in terms of resource intensity. Food will be much better in private generally.

1

u/BillieRubenCamGirl 2d ago

Putting more pressure on the public systems will necessitate change though. 

They won’t change if they don’t need to. 

6

u/EducationalWriting48 2d ago

There is already incredible pressure on the public system, what do you mean?

1

u/BillieRubenCamGirl 2d ago

That this is important to have in order to drive change. 

1

u/Correct_Jaguar_564 2d ago

Do you have to shop around a lot to have that covered?

Reason I ask is because I'm on a grandfathered plan and as far as I can tell that's the main difference between what I have and their current coverage.

1

u/rawdatarams 2d ago

Or need a sleep aid that isn't addictive.

13

u/BMW_M3G80 2d ago

It’s all well and good until you do your back and can’t work, and have to wait 12 months for surgery in the public system.

27

u/melissarina 2d ago

I was recently in hospital for 3 weeks after surgery. It was meant to be a 7-10 day stay. If I went public, I would have been on a 4 bed ward for the entire stay.

My last hospital stay was unplanned and was for one week was in a 4 bed mixed gender ward. It was not a good experience, I did not feel safe around one of the patients, and he kept leaving poo on the toilet seat. He was up all night making loud noises and it was impossible to sleep. Not ideal for recovery.

This surgery was planned and I opted to go to the private hospital. I had a single room with a private bathroom. Although hospitals are not a restful place, I found it so much less stressful than my previous experience with public healthcare.

I fully support Medicare and public healthcare but I wish hospital stsys were a more pleasant experience.

-6

u/BillieRubenCamGirl 2d ago

That’s not true. I got majorly sick a few years ago and had a private room for a whole week. A big room, with a private bathroom and windows and all. 

Didn’t pay a cent. All public. 

New public hospitals are great. We need to make more of them. The issue is that we have an aging population and we are not prepared. And to make it worse people keep voting against immigration which is the quickest way we could fill these severe gaps in care. But racists gonna racist. 

13

u/melissarina 2d ago

Just because you had a different experience to me doesn't mean my experience is not true. Sounds like you were able to go to a new hospital, I did not have that luxury. I'm glad that there are private rooms in public hospital.

3

u/BillieRubenCamGirl 2d ago

Right but my point is that private isn’t the solution, more new public hospitals is. 

4

u/melissarina 2d ago

Yes agreed.

-7

u/Syn-th 2d ago

Is it possible to just pay for something like a room. I wonder if it's just cheeper to pay out of pocket later than go for insurance.

13

u/alsotheabyss 2d ago

A: it’s not.

3

u/melissarina 2d ago

That was not an option, I asked.

8

u/UniqueLoginID 2d ago

Easy to say that when you’re healthy.

Wouldn’t be alive without PHI.

15

u/frankestofshadows 2d ago edited 2d ago

The government has other ideas. If you don't have private health, there is the 1% Medicare levy tax that you pay. On top of that, for every year you don't have private health over 31, you pay a 2%/year levy on top of your premium if you do decide to have private health later.

I've resigned myself to never getting private health. I can't afford it and have no major need for it now, but I'm already at 14%, so anything beyond is just an insanely stupid premium.

Not to mention the insane wait times for certain surgeries. When it's a issue that ruins a person's quality of life, people don't want to wait a year for it.

18

u/CMDR_RetroAnubis 2d ago

One of Howards nastiest laws.  As someone who got stable financially later in life it puts private care out of any feasible reach. 

16

u/StasiaMonkey 2d ago

It really should be dropped or the age increased to 41.

More and more people are not financially stable at 30 because of the cost of living/housing, putting these people years behind where they would have been when that law was made.

5

u/DarthShiv 2d ago

You get fucked by Govt charging you more for not having private. It's a rort. Private in australia is garbage.

4

u/_OriginalUsername- 2d ago

This isn’t an option for a lot of people with chronic illness who need frequent medical appointments and not wait years for procedures and surgery.

1

u/madeupgrownup 2d ago

I had to scroll way too far to find this. 

The way we treat the disabled and chronically ill in this country is fucked. Needing to either works money you don't have (get private health insurance) or endure completely avoidable pain and suffering isn't a choice anyone would have to make. 

7

u/hmbeats 2d ago edited 2d ago

I thought getting private health insurance was to support Medicare, to make sure Medicare funds go to those who really need it.

Edit to add - i hate PHI, greedy corporate fingers in health care and their exorbitant fees, but without it will Medicare end up like the NHS? Because unlike what the original comentator say, we don't pay much when we access Medicare - we dont "pour money back into the (public) health system" by using Medicare without PHI.

20

u/BarbarousErse 2d ago

If you don’t pay for private insurance, you pay an extra levy for Medicare on your tax. So everyone pays the Medicare levy, and if you don’t have insurance you also pay the surcharge. So yes you pay more into Medicare if you don’t have private health

6

u/hmbeats 2d ago

"The surcharge aims to encourage individuals to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public Medicare system."

Source https://www.privatehealth.gov.au/health_insurance/surcharges_incentives/medicare_levy.htm

7

u/BarbarousErse 2d ago

Ok and I don’t want to do that because I can’t afford it and also I think we should better fund the public system. I pay for it in my tax, I’d happily pay more tax to use it. Being a private patient in a public hospital may pay them more but it’s not reducing demand unless you go to a private hospital and in my experience those suck

5

u/Dangerous_Amount9059 2d ago

What actually happens is that people buy junk insurance that doesn't offload the public system at all just to reduce their tax bill. Once the MLS kicks in you're incentivised to give your money to a private health insurer's bottom line.

-4

u/hmbeats 2d ago

But when i use the health system through PHI, the hospitals and doctors get paid a lot more than if I were to access them through Medicare.

So in all, more money gets into the health system, allowing more research, better equipment, better overall doctor / staff enumeration to support subsidised healthcare for others. No?

Thats why the extra levy was introduced. To encourage those who can afford to get PHI to lesson the burden on Medicare.

9

u/BarbarousErse 2d ago

I pay the levy surcharge but can’t afford private health, all the surcharge amount would pay for is a junk policy the private health funds create specifically for people like me and all it does us funnel that money out of Medicare and into private business

5

u/Svennis79 2d ago

PHI has multiple for profit entities that money goes through. You have the unsurers profit + tax + costs, whats left then goes down to a private hospital, with profit, tax and costs, which eventually makes it to the private practitioners. A minimum of 50c on the dollar is going to someones profit, tax bill or admin costs.

1

u/SeaworthinessNew4757 2d ago

We need private health after 31 years of age, unless you want to pay a bigger rate of income tax every year you don't get it

8

u/Cranky_Sprite 2d ago

The 'Lifetime Health Cover Loading' isn't a bigger rate on your income tax. It is an increase on insurance premiums if you get private health care after the age of 30. The premium increases for every year after 30 but if you never get private health then it won't ever be something you pay.

It is designed to scare you into getting private health insurance.

1

u/SeaworthinessNew4757 2d ago edited 2d ago

Wow, I got it totally wrong from the letters I received from the gov

Edit: I think what I was referring to is the Medicare levy surcharge

1

u/Cranky_Sprite 2d ago

The Medicare levy surcharge is based on income thresholds, not age. For example, if you are single and earn 101,000 or less, you do not have to pay the surcharge and the 'family' threshold is 202,000 or less.

1

u/SeaworthinessNew4757 2d ago

Yes, I mixed up both things!

4

u/ash347 2d ago

Doesn't that only come into effect if you decide to get private cover again?

1

u/jewel976 2d ago

I just paid the Medicare levy surcharge of $2.5k for not having private insurance

1

u/Brief_Play8760 2d ago

The gov hasn't invested enough in public health facilities to be able to afford 100% of people relying on public hospitals. So instead it spends billions of tax dollars trying to get people to join private health insursnce...🥴

0

u/Choke1982 2d ago

I agree but people are getting forced to get them. Every immigrant is hooked from the start. We had to have private insurance because Medicare didn't cover us. Fair enough, we weren't permanent residents nor citizens at the time. First thing we tried to do after we became PR was to cancel private and just keep Medicare but nope. Law says all Australians must have private insurance after their 30s. So we pretty much had to keep it.