Vast differences in benefits between insurers for the same operations

Private health insurance providers are charging drastically different out-of-pocket costs for common procedures, a new report has found.

The Australian Medical Association’s Private Health Insurance Report Card for 2021 revealed huge discrepancies between providers.

It highlights the staggering differences in benefits paid by insurers for the same operation – even if they’re done by the same doctor in the same hospital.

For coronary bypass surgery NIB will return a benefit of $3444. (AAP)

For example, a hip replacement should be free of charge for an insured patient under a “no-gap” arrangement.

But for some patients, it can cost a $500 excess, while others could be out of pocket by more than $1300 depending on the insurer.

The difference in benefit for an uncomplicated birth can be as much as $560 ($564) – NIB paying back just $1600 ($1613) and HCF almost $2200 ($2178).

President of the Australian Medical Association Dr Omar Khorshid has called for a tighter lockdown in Sydney.
President of the Australian Medical Association Dr Omar Khorshid. (Alex Ellinghausen)

For coronary bypass surgery NIB will return a benefit of $3444 while AHSA members get $4246 – a difference of $800.

“There’s a lot that a consumer can do to make sure they have the best possible experience when it comes time to claim,” AMA President Omar Korshid told 9News.

He said people should do their research when choosing a fund to determine whether it will look after you when a claim is made.

The latest report comes as health funds made a $1.8 billion after-tax profit in the year to September thanks to savings from members not accessing healthcare during lockdown.

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