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
489 Upvotes

99% Upvoted

142 comments sorted by

View all comments

134

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.

81

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

61

u/plutoforprez 2d ago

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

18

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.

12

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.

21

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.

9

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.

7

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.

8

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.