The $4.5bn hole in your health insurance

Christopher Zinn explains why you would register with One Big Switch and look at your health insurance options.

AUSTRALIANS with health insurance have had to pay an extra $4.5 billion in gap payments just for the privilege of using their "cover" at a hospital or dentist.

Out-of-pocket costs have risen by $580 million, or 15 per cent, in the past three years, official statistics from the Private Health Insurance Administration Council show.

PHIAC's latest report on the industry also finds that policy holders still end up paying half the total cost of dental, optical and other non-hospital treatments - a $3.5 billion bill last financial year alone.

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And in what is believed to be a first, News Limited has obtained data from the two largest insurers that reveals widening gaps for some common procedures.

Among the 3.5 million members of second-ranked Bupa, the average gap for wisdom teeth removal increased by 24 per cent between 2008-09 and last financial year, from $161 to $199. For the 3.7 million people with the largest insurer, Medibank Private, the wisdom tooth average in 2011-12 was $394. Medibank repeatedly declined to say what the percentage change had been, only that "gaps for wisdom teeth have decreased significantly then stabilised". Medibank would not discuss why its gap was twice Bupa's.

While a person with private cover is up for half the cost of non-hospital treatment, PHIAC figures show insurers typically pay a bigger chunk of hospital bills. But gaps vary greatly. They meet 99 per cent of the bill for treatment in an intensive care unit - up from 97 per cent in 2008-09 - but a policy holder who requires orthopaedic surgery still pays an extra amount equal to a quarter of the operation's cost.

The Bupa gap on eye surgery has risen by 19 per cent since 2008-09, from $293 to $350. Medibank refused to say.

For Bupa members, out-of-pocket costs for hip replacement have risen 17 per cent to $1134. The gap has also increased with Medibank, to $2020. It wouldn't say why its gap was so much bigger.

Bupa's data shows that since 2008-09 the gap for delivering a baby had fallen four per cent, and was down 13 per cent for heart bypass surgery. Medibank refused to provide data on births but said bypass out-of-pockets were "stable".

A Bupa spokesman said members facing hospital treatment should "talk to us first".

"We try to help them understand what they're entitled to under their cover so there aren't any unexpected costs, as well as discuss ways for them to reduce or avoid out-of-pocket costs," the spokesman, Matt Allison, said.

To reduce the gap on dental, optical, physiotherapy and chiropractic services, Bupa advised using its Members First preferred providers.

Medibank refused to provide any advice.

Since 2008-09, gaps have declined slightly as a slice of total cost, from 23 per cent to 22 per cent. Medicare continues to pay nearly 11 per cent. Insurers fund the rest.

The Big Health Insurance Switch campaign, which aims to create the first discount cover open to all Australians, had attracted 49,000 registrations by 7pm AEDT yesterday.

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