Health Insurance coverage for a 40 something cyclist?

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TheShadow
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Health Insurance coverage for a 40 something cyclist?

Postby TheShadow » Tue Jan 12, 2016 6:54 pm

When I was younger I did a reasonable amount of training and really only a little racing for a number of years. Pretty sure I didn't damage my knees or hip joints. Near enough to never had any pain in those areas.

Many years later, and having resumed a relatively mild 'training load' in which I specifically don't try to push myself too hard, is it wise for me to be considering a health care policy that EXCLUDES: knee and hip, and also spine surgery?

I feel completely fine in those areas, although the knees do click or clunk a tiny bit when standing up sometimes. Enough that a physio will laugh at me. (I tried to tell them it means nothing :| ) I don't consider there's anything wrong with them. Hoping and planning to never have replacements on those joints. I haven't ever really ever done any intense running or other high impact sports. I have always disliked running.

I do have a bone spur in my neck that is relatively minor as far as these things go - the spine surgeon said it's not worth operating on. I eagerly took him at his word on that. But, I do think that is a result of riding/crashing bicycles for a number of years long ago. I'm just wondering if there's some knee/hip problem I should anticipate - or if I'm actually in better shape in that department than a completely sedentary person (who may be carrying over 10kg excess weight) or an ex-footballer who got pounded into the ground on his knees on a regular basis.

Mostly what I worry about with health insurance is accident coverage. And some kind of health problem you just can't anticipate.

I find it frustrating when shopping for health insurance, knowing that so much of it is geared for people who do little or nothing to take proper care of themselves. I realise that's because many of them are too busy and tired to do so. Sometimes they have a choice regarding that, some don't. It's poor economics and quality of life either way, imho.

Is there a health fund just for cyclists? If not, why not? :?:

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cyclotaur
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Re: Health Insurance coverage for a 40 something cyclist?

Postby cyclotaur » Tue Jan 12, 2016 7:52 pm

Your goal should be sensible risk management and self-insurance. Aim to make your household financially independent of health insurance. Save bogus 'health insurance' premiums, invest wisely, spend carefully and build your own financial buffers against bad times or unforeseen expenses. Although better to have started in your 20s than your 40s... [emoji52]

You won't find any reasonable health insurance products - they are a taxpayer subsidised industry scam IMHO.

In a largely privatised hospital/medical environment (and a scandalously underfunded public one) those who need help can't afford insurance and people who can should be able to pay their own bills anyway.

I'm no help am I ... [emoji849]
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TheShadow
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Re: Health Insurance coverage for a 40 something cyclist?

Postby TheShadow » Tue Jan 12, 2016 9:45 pm

Thanks for your perspective, Cyclotaur. It is a difficult issue. The government certainly tries to intimidate everyone into having at least hospital insurance. Extra tax for the wealthy who opt out and 2% extra added to the premiums of everyone for every year outside the system, should you go it alone for a number of years and then decide to resume insurance (no doubt right as you are getting older and requiring more healthcare).

I was thinking of just getting a very minimalistic hospital cover that meets the Lifetime Health Cover regulation. (the one that punishes you if you leave completely then come back to health insurance)

Mostly all I see some average 'comprehensive' policy with Hospital plus "Extras" returning to me, is several hundred dollars of routine dental check-up and clean, with maybe an X-ray or a small filling thrown in. And maybe 4-6 visits to a physio (I rarely ever go to them now because I know what to do in the first place - I use them if I've had an accident causing injury). BUPA, for instance, does not give you much to go to a physio, imo. They also don't give you a heck of a lot of dental work, imo.

I think a few years of Insurance policies saved in the bank would cover a lot of major dental work, although the prospect of a major crown or bridge eventually (years, a decade, away for me I think) would be concerning. Some of that major dental work pricing is, um, questionable and completely outrageous? :shock: (I hear about it from my parents.) Cue the overseas holiday to a developing country where dental work is still relatively cheap....Hola!

For hospital coverage, I really feel it's only a severe accident that I need it for, although probably no one anticipates getting cancer, for instance. For an accident, tho, is the public system so terrible? I really don't know. (Hope I never do have a collision that serious!) IT seems like the biggest problem with the public system is the nasty health problems that have long waiting lists, leaving you in pain and perilously hanging onto life even, for months, while you wait in a queue. :| I've read newspaper stories of some people who don't make it to the head of the cue. :shock:

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matagi
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Re: Health Insurance coverage for a 40 something cyclist?

Postby matagi » Tue Jan 12, 2016 10:01 pm

TheShadow wrote:T
For hospital coverage, I really feel it's only a severe accident that I need it for, although probably no one anticipates getting cancer, for instance. For an accident, tho, is the public system so terrible? I really don't know. (Hope I never do have a collision that serious!) IT seems like the biggest problem with the public system is the nasty health problems that have long waiting lists, leaving you in pain and perilously hanging onto life even, for months, while you wait in a queue. :| I've read newspaper stories of some people who don't make it to the head of the cue. :shock:
The waiting lists are for elective procedures - if you get diagnosed with a nasty cancer or get smashed up in a serious accident and require immediate and major life saving surgery, I can assure you that you will be on the table quickly regardless of your insurance status. It's the elective procedures you want private insurance for ie. joint replacement surgery, arthroscopy, etc.

cp123
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Re: Health Insurance coverage for a 40 something cyclist?

Postby cp123 » Wed Jan 13, 2016 12:32 pm

my friend (pensioner) was on the lift for a hip replacement. still relatively able, mobile, enough to walk his dog quietly but limped everywhere. 18 months later he was still in the queue, seriously crippled and barely about to move. so much so that awkward walking while crooked lead to significant deterioration of his good hip. it took about 2 and a half years to get the operation. too bad it sent him down the path to crippledom in the meantime.


sorry - the point is - he couldn't afford to pay for the operation, but just had to grin and bear it for ages at the mercy of the system. with no flexibility as to doctor, timing or hospital. it was be there or be square when finally directed.

toofat
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Re: Health Insurance coverage for a 40 something cyclist?

Postby toofat » Wed Jan 13, 2016 1:46 pm

an employee of mine paid private health premiums all his working life that he could barely afford,
in his late fifties he badly needed a hip replacement but his doctor knew that he could never afford the gap payment so he was put on the public waiting list and kept on opiates for the pain for the 9 months it took to operate,

a year later he had cronic stomach pain and back in the private system, was given antibiotics and then medication for stomach ulcers with many weeks gaps between prescriptions then finally a scan that showed something wrong, then a more costly scan that showed the cancer was too widespread and serious to operate and he wasted away for 4 months before dying 4 years ago tomorrow.
my sister in law is an oncology nurse and has been for many years and also on the private system, when she discovered a breast lump she feared the worst but the tests came back benign and sugested a non malignant cyst but she knew something was not right
she then went via the public system and got to see one of the leading specialists, the same test were done with the same results but further more complex tests were done which showed quite advanced cancer, she got immediate chemo treatment and after a bit of recovery a masectomy and it was in time to stop the spread to other parts of the body
she is not in the clear yet but things look a lot more promising
my take on this is that the private system has far more limited funds for testing and much like an insurance company always have an eye on limiting payouts,
to me the worst part of private is not knowing what the gap is , at least with an insurance policy you know the excess
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dalai47
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Re: Health Insurance coverage for a 40 something cyclist?

Postby dalai47 » Wed Jan 13, 2016 3:46 pm

In regards to cancer, also hope you have one of the common cancers.

My wife has a rare cancer. There is an immunology drug that is showing promise, but as her cancer is not Lung or Melanoma - instead of the PBS rate of under $100 if we want to try it are looking at $19,000...

She has Private Insurance so have been getting treated through the private system; we have only paid the capped excess for the repeated hospital visits but have been paying for the numerous CT scans and the PET scan.

moosterbounce
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Re: Health Insurance coverage for a 40 something cyclist?

Postby moosterbounce » Thu Jan 14, 2016 12:42 am

It is all abut risk assessment. And luck. There are good and bad stories through both private and public systems. Personally, I had a good story - about $15k in medical expenses (and still going) and most was covered by HBF. Private room, private hospital, one of the best surgeons in the field (I didn't know that at the time), surgery bills including metal bits...covered 100%. My payments have been the gap that medicare leaves behind, and ongoing physio that my private insurance covers about half of with a yearly limit. Not everyone needs to have physio weekly for 1-2 years.

Anyway, I'm early 40's and had a spill from the bike at maybe 30kmh, riding alone. I broke my shoulder to the point that they were attempting to save the bone as I was too young for a joint replacement. So far it's been good, but I'm high risk of failure and a replacement for 2 years from date of accident. I was fit, healthy, no signs of osteo issues, pretty muscly with no sharp pointy bits sticking out to break easily (ER doc said my shoulders were so chunky it was difficult to see any difference between the two despite the fact that one was broken into lots of pieces).

My point is that age and doing high risk activities do not dictate the need for things like joint replacements. I used to think that but having see how easy it is to be so close to one, I now know different. There are people around here who have had joint replacements at your age and earlier due to accidents...and things like avascular necrosis kicking in (which is my risk). My injury was unlucky and at no point did it tick the "most fractures of this type..." statistics.

You never know what is around the corner so please don't think your age, risk activities and current fitness mean that you are exempt. Murphy doesn't work like that ;)

TheShadow
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Re: Health Insurance coverage for a 40 something cyclist?

Postby TheShadow » Thu Jan 14, 2016 2:31 pm

moosterbounce wrote:Anyway, I'm early 40's and had a spill from the bike at maybe 30kmh, riding alone. I broke my shoulder to the point that they were attempting to save the bone as I was too young for a joint replacement. So far it's been good, but I'm high risk of failure and a replacement for 2 years from date of accident. I was fit, healthy, no signs of osteo issues, pretty muscly with no sharp pointy bits sticking out to break easily (ER doc said my shoulders were so chunky it was difficult to see any difference between the two despite the fact that one was broken into lots of pieces).
That's the kind of thing I've always been concerned about. You were not in danger of losing your life, yet in a lot of pain, and I imagine significantly unable to use your upper body at all. And the situation could well significantly deteriorate unless seen to immediately due to the blood flow the bone and all that stuff.

Is the public system going to be in any great hurry to help you fix this, if at all? And if so, can you be sure you're getting the best advice and treatment available? Some earlier posts pointed out some of the best doctors are in the public system; I think most of them allocate a significant portion of their time to the public system even. But even if that is the case, it might take quite a while to see them publicly if the condition is not life-threatening. Even the cheapest hospital policies seem to cover ALL procedures that are accident related. So even if you do have an exclusion on hip, knee and spine surgery - if it's accident that caused your problem, you can get it all done privately like you did.

I also just read the thread in this forum (down the page a bit) titled "Break your bones while riding", and it freaked me out a bit. There were some guys who'd come off at high speed and done damage to their knees that they didn't initially appreciate was quite so serious. They got treatment, but seem to be suffering long term consequences.

I think if you had basic accident coverage for everything hospital related (combined with a general exclusion on hip, knee, spine work caused by normal wear & tear degeneration) then if you did sustain accident damage which seemed to be taken care of by your private insurance, then THAT would be the time to boost your coverage level so that if longer term consequences materialized and the insurance company said they were not accident related (seems likely), then you could have it taken care of.

madmacca
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Re: Health Insurance coverage for a 40 something cyclist?

Postby madmacca » Thu Jan 28, 2016 4:47 pm

The posters in this thread have highlighted some key aspects of the overall health system.

If it is urgent or critical care that you need, the public system is excellent. The increasing specialisation of medicine means for less common conditions, only in the public system is there enough volume for some specialists to keep their skills sharp.

Where the public system falls down is the waiting lists for non-critical care. If you are not going to die from it if left untreated, you can find yourself on a long waiting list, even if in debilitating pain or your condition is slowly deterioriating.

To bring this back to the OP's question, given that anything spinal has the potential to be crippling but not fatal (ie. long waiting list stuff), spinal is probably not the sort of thing I'd want to leave out of private insurance - especially as spinal problems may have you off work as well.

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