Health care providers are taking the scalpel to your benefits again

Two of Australia’s most popular health funds are forcing doctors to sign declarations before performing certain surgeries on patients. Medibank

Two of Australia’s most popular health funds are forcing doctors to sign declarations before performing certain surgeries on patients. Medibank Private and Bupa are reportedly overruling doctors recommendations and cancelling surgeries they do not deem to be necessary. The health funds are forcing doctors to sign declarations to prove the surgery is necessary and the patient is deserving of benefits.

The forms are meant to determine whether or not a procedure is cosmetic, despite the fact that doctors are claiming Medicare rebates for the surgeries, which would indicate they are needed for the patient’s health.

Some of the types of surgeries in contention are procedures on eyelids and the tear-duct system. While Medibank Private and Bupa might not consider these surgeries necessary, the people suffering with these conditions would surely disagree – as do their doctors.

Speaking on the issue yesterday, Australian Society of Ophthalmologists president Michael Steiner said surgeons were scheduling operations for patients, only to have the health funds question their motives.

He said he was aware of several instances where surgeries had been cancelled because doctors refused to sign the forms, including one case where an elderly patient had travelled three hours to the hospital only to be told the procedure was not going ahead.

“These two funds are putting themselves above Medicare,” Dr Steiner said.

But a Bupa spokesman disagreed, saying the process “provides certainty to the member and hospital that a procedure is clinically required, ­ensures payment of a member’s claim and helps protect the integrity of the Medicare rules”.

This is dangerous territory for a number of reasons – particularly because of the possibility of health funds gaining too much control over the system. This is already a huge issue an America, where health funds have a monopoly over the system and can easily cancel or deny patients’ surgeries.

Another issue that is yet to be addressed is that of payment, with some people wondering why they are paying so much for private health when they can’t even get the surgeries they want and need.

Do you think think Medibank Private and Bupa have overstepped the line? Are you worried about health funds having too much control?

  1. But they can give millions and millions for overseas this is our taxes they are giving away please stop

  2. This is the surgery I had and trust me it was needed.Stopped my eye tearing all day. It was both annoying and affecting my vision. I was constantly rubbing and blotting my eye

  3. Just gotta ask yerself, did i vote Liberal. Simple really.

    • Noel if you think Labor will be any different I feel very sorry for you as they are no different anymore. You silly people that are stuck in the old times of politics need to open your eyes and really look at what is happening because you are the ones who are pulling this country down. Labor, Liberal and Greens don’t care anymore about us they are only there to fill there own pockets and look after there friends in big business who are also lining there pockets. Wake up before it is to late.

  4. I thought the whole idea of private insurance was so you could have elective surgery

  5. Jan dodson  

    Ditch Bupa and Medibank and find one that doesn’t over ride yr surgeon

  6. Editor I think if you read the report correctly the funds are not requesting that Doctors sign before the surgery but afterwards. When the Medicare code they use on the claim denotes something akin to cosmetic surgery – the fund requires the doctor to sign that it was not actually cosmetic surgery. This is because Medicare (read taxpayer) does not make a contribution to surgery that is purely cosmetic and neither do the health funds.

  7. We seem to be headed toward the American system where life saving surgery is denied as it is deemed experimental. If my doctor and specialist feel a particular surgery is required that should be enough. My husband had skin cancer removed and forms had to be filled out to say it wasn’t just cosmetic.

  8. I’m glad I’m not with either of these funds. I thought I was in for some heavy expense having cataract surgery, not laser but replacement of the lenses in both eyes, each lens quoted at $2,300. Thank you to Naval Health for covering this and much more. Of the near $4,000 per eye, Medicare came up with $750.

    • Well the fund set up by a well known deceased eye specialist whose name escapes me can perform this surgery in thurd world countries for $20per eye. I imagine the surgery is the same technique as is used in Australia and the lens is obviously the same so who is making the profit between the $750 medicare will pay and the $4000 the eye specialist is charging something is not right in this equation though it is not you as you are just the poor fool who has to pay the bill and they have rather got you backed into a corner because you options are pay the exorbitant bill or go blind..make sure you children become doctors they will keep you comfortable in your elderly years.

    • No Joan. You did not read my post properly. Fred Hollows did laser surgery, mine is totally different and many years later. My mother had laser surgery, again so totally different, times change and methods of treatment change and improve. The techniques are do totally different. I am not complaining about the cost, that is why I love my health insurance company.

  9. This needs to be stopped NOW, why are they given so much power? They are definitely overstepping the mark.

Leave a Reply

Your email address will not be published. Required fields are marked *