# Health Cover for Pre-existing Condition



## cookiesinthedark (Oct 14, 2013)

I'm looking for help with a complicated medical insurance coverage situation. Any advice is greatly appreciated!

Here's the overview:
- I am an American citizen (currently in the US) with a chronic health condition that requires daily medication and occasional visits to see a specialist.
- I recently accepted a job in Melbourne; it's a 2-year position starting June 2014.
- The Australian 457 work visa application requires proof of medical insurance.
- Australian health cover plans all have a 12-month waiting period for pre-existing conditions, and I need my condition covered.
- US health cover plans only cover emergencies internationally.
- International health cover plans do not cover pre-existing conditions.

Does anyone out there have a similar situation? Thanks!


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## GBTUSA (Oct 10, 2013)

cookiesinthedark said:


> I'm looking for help with a complicated medical insurance coverage situation. Any advice is greatly appreciated!
> 
> Here's the overview:
> - I am an American citizen (currently in the US) with a chronic health condition that requires daily medication and occasional visits to see a specialist.
> ...


Here is a link I found for medical Insurance:

http://www.immi.gov.au/skilled/457-health-insurance-faq-visa-holder.htm

I think you can go out and buy from Private Insurance Companies(PIC). Just Google for PIC and call them..you'll get an idea.

I too have a medical condition that needs medical attention. I'm trying through Visa subclass 190. I am a US citizen living in the southeast.

Let me know how it went


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## GBTUSA (Oct 10, 2013)

cookiesinthedark said:


> I'm looking for help with a complicated medical insurance coverage situation. Any advice is greatly appreciated!
> 
> Here's the overview:
> - I am an American citizen (currently in the US) with a chronic health condition that requires daily medication and occasional visits to see a specialist.
> ...


here's one more website with Healthcare insurance info.

PrivateHealth.gov.au - Australian Health Insurance Information


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## cookiesinthedark (Oct 14, 2013)

Thanks for the response! All of the private insurance companies I've contacted have a 12-month waiting period before they cover any care related to a pre-existing condition. I was told they all have this wait. Have you found one that doesn't have this waiting period?


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## espresso (Nov 2, 2012)

Hi cookiesinthedark, 

as far as I know all private insurance companies have this 12-month wait period for pre-existing conditions. In your case there are two things to consider: 

1.) You need a health insurance that *meets* the Department of Immigration and Border Control (DIBP) *requirements*. This one is easy - there are quite a few options if you google, e.g. here. Maybe your employer also has agreements with certain insurers in place, which should get you cheaper/extra cover. 

2.) You need to find out *how much your existing health condition will cost you* in out-of-pocket expenses and if there is an option to get cover for it via insurance. 

The main problem is that you won't be covered by the Pharmaceutical Benefits Scheme (PBS) and Safety Net, which helps out if your medication costs are high. You can look up PBS prices for medicines here. Even after the waiting period most private policies only have limited cover for medication. You should talk to your prospective employer once you know how much it will cost you to pay for medication during the first year. Depending on your condition, the costs may make quite a dent in your salary...

All the best, 
Monika


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## cookiesinthedark (Oct 14, 2013)

Thanks Monika!

To be clear, are the prices on the PBS site the cost with or without insurance? I've been trying to estimate my total costs, but this is difficult not knowing what diagnostic tests, specialist visits, and prescription meds cost out-of-pocket in Australia. Prices are definitely very different there compared to in the USA. 

Jen




espresso said:


> 2.) You need to find out *how much your existing health condition will cost you* in out-of-pocket expenses and if there is an option to get cover for it via insurance.


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## ozbound12 (Mar 23, 2012)

cookiesinthedark said:


> Thanks Monika!
> 
> To be clear, are the prices on the PBS site the cost with or without insurance? I've been trying to estimate my total costs, but this is difficult not knowing what diagnostic tests, specialist visits, and prescription meds cost out-of-pocket in Australia. Prices are definitely very different there compared to in the USA.
> 
> Jen


Hey Jen - fellow NYer here, welcome.

If you already have a similar level of cover and are just switching to a new cover, the 12-month rule generally doesn't apply. Obviously you have never had health cover here before, but you may be able to claim that you have had cover based on your existing insurance in the US. I would recommend ringing up one of the providers you're interested in to see if this applies (or email them if you don't want to pay the long distance charges).

Otherwise, I don't think you'll be able to get your condition covered and may incur significant out-of-pocket expenses.

As for PBS, generally only PRs and citizens can get prescriptions at subsidised prices unless your health cover includes prescription coverage in which case they will pay the difference.

I remember seeing a list of what Medicare covers somewhere online with prices (for what they cover). Medicare generally doesn't cover the full amount of any procedure but it would at least give you an idea of what your out-of-pocket expenses might be. I can't find it now but I'll see if I can do some searching later.


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## espresso (Nov 2, 2012)

Hi cookiesinthedark, 

yes, the PBS prices are *WITH MediCare* cover - that's what PR holders and citizens pay for their subsidised drugs. You can try looking for your drugs on chemistwarehouse.com.au - they list the PBS prices but also prices for private prescriptions. They don't list all drugs online, though... 

Best of luck, 
Monik


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## cookiesinthedark (Oct 14, 2013)

Thanks! 

No luck with getting any coverage for the pre-existing condition, but it seems that my medication costs less in Australia *without* insurance than it does in the USA *with* insurance. No joke. 

Also, the MBS site (mbsonline.gov.au) is proving useful for estimating costs for doctor visits, assuming the doctors don't bill (i.e. charge more than what Medicare pays for Australian citizens). 

I may still need to pay for 2 insurances + out of pocket for the pre-existing condition, but this is definitely progress!


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## ozbound12 (Mar 23, 2012)

Aha! Found it... MBS Online - Welcome to MBS Online

That site has the list of every service that Medicare covers as well as the prescribed fee for each service. Since you won't have access to Medicare you will likely have to pay a higher fee than what is listed here but it should give you an idea of the cost of services.


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## ozbound12 (Mar 23, 2012)

cookiesinthedark said:


> Thanks!
> 
> No luck with getting any coverage for the pre-existing condition, but it seems that my medication costs less in Australia *without* insurance than it does in the USA *with* insurance. No joke.
> 
> ...


Most doctors (the good ones) charge more than the Medicare rate (this is called "bulk billing" here) so there is almost always a gap.


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## cookiesinthedark (Oct 14, 2013)

That's really good to know - thank you! Is that the case for diagnostic tests too? How much more would you estimate the [good] doctors bill relative to the Medicare rates? For example, would double the cost listed on the MBS site be expected?


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## GBTUSA (Oct 10, 2013)

Ozbound12 and Espresso,

I'm glad I found this site. I'm also planning a move to Australia from US(FL)under Visa 190.

I have pre-exisiting medical condition which needs regular medical check ups and medicines...I am a insulin dependent Diabetic. 

is it going to be an issue for getting the visa? how do I handle it?


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## espresso (Nov 2, 2012)

Hi GBTUSA, 

check the Panel Members Instructions (= guide for doctors how to conduct the medicals). As a general guideline only severe cases of diabetes, where damage has been done to end organs (eyes, sensory loss in limbs etc.), will be a problem. The classification is: 


> *Diabetes: *
> *A-Grade: *If stable with no evidence of end-organ damage.
> *B-Grade:* End-organ complications known or suspected, especially renal impairment. Provide relevant investigation results. Specialist report not required unless requested


All the best, 
Monika


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## GBTUSA (Oct 10, 2013)

espresso said:


> Hi GBTUSA,
> 
> check the Panel Members Instructions (= guide for doctors how to conduct the medicals). As a general guideline only severe cases of diabetes, where damage has been done to end organs (eyes, sensory loss in limbs etc.), will be a problem. The classification is:
> 
> ...


Thank you!

BTW, how do I get a PCC(police clearence certificate) in US? should I get it from the FBI or local police?


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## ozbound12 (Mar 23, 2012)

GBTUSA said:


> Thank you!
> 
> BTW, how do I get a PCC(police clearence certificate) in US? should I get it from the FBI or local police?


If you are currently living in the US you need to get a PCC from the FBI as well as your state police.

FBI: FBI — Submitting a Criminal History Summary to the FBI


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## ozbound12 (Mar 23, 2012)

cookiesinthedark said:


> That's really good to know - thank you! Is that the case for diagnostic tests too? How much more would you estimate the [good] doctors bill relative to the Medicare rates? For example, would double the cost listed on the MBS site be expected?


Diagnostic tests vary in price depending on the test performed. As for doctor's visits, my GP usually charges $69, of which I get back $36 from Medicare. (Unfortunately, the "gap" I pay here is higher than it was when I was living in the US and had insurance...)

There's the after hours GP that bulk bills; I assume if you don't have Medicare you would just pay the normal Medicare rate. I've never used them but my neighbour has and she seems to have had a good experience with them. After Hours GP Brisbane, Perth, Sydney & Melbourne - Bulk Billing Home Doctor - Medical at Home

If you're seeing a specialist, expect to pay a higher fee.


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## GBTUSA (Oct 10, 2013)

ozbound12 said:


> If you are currently living in the US you need to get a PCC from the FBI as well as your state police.
> 
> FBI: FBI — Submitting a Criminal History Summary to the FBI


Do I have to get PCC for my wife and kids too?


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## ozbound12 (Mar 23, 2012)

GBTUSA said:


> Do I have to get PCC for my wife and kids too?


Wife yes, children only if they are 16 and over.


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## cookiesinthedark (Oct 14, 2013)

My application for Australian health insurance was denied based on the medical report from my neurologist. I plan to apply through other insurance companies as many times as it takes, but is there any way to increase my chances of getting approved? Based on the Australian health care system, might particular aspects of the report be flagged? (If so, perhaps I could ask my neurologist's office to spin the report a certain way.) Thanks!


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## ozbound12 (Mar 23, 2012)

cookiesinthedark said:


> My application for Australian health insurance was denied based on the medical report from my neurologist. I plan to apply through other insurance companies as many times as it takes, but is there any way to increase my chances of getting approved? Based on the Australian health care system, might particular aspects of the report be flagged? (If so, perhaps I could ask my neurologist's office to spin the report a certain way.) Thanks!


I don't think it has to do with the Australian health care system specifically but more to do with the insurer. Without knowing anything really about your condition, I'm assuming the insurer probably did the calculations on the cost of treating your condition and deemed it to be too costly for them to cover it. If that's the case I'm not sure if there's any way to spin your reports such that the insurers will be more likely to cover you.


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## cookiesinthedark (Oct 14, 2013)

thanks. I'll just keep trying. 

I have epilepsy that has been very unpredictable and severe in the past (brain surgery, hospitalizations, many medications including one that caused permanent vision and endocrine problems). However, due to a special ketogenic diet it's been very well controlled with little medication for 1.5 years. 

The ironic part is that the job I have lined up in Australia is a postdoctoral research position in which I'll be studying epilepsy.


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## GBTUSA (Oct 10, 2013)

cookiesinthedark said:


> thanks. I'll just keep trying.
> 
> I have epilepsy that has been very unpredictable and severe in the past (brain surgery, hospitalizations, many medications including one that caused permanent vision and endocrine problems). However, due to a special ketogenic diet it's been very well controlled with little medication for 1.5 years.
> 
> The ironic part is that the job I have lined up in Australia is a postdoctoral research position in which I'll be studying epilepsy.


Why don't go on a Visitor visa, stay there for a month or two and explore your options? sitting here in the US with 15 hr time difference you won't be able to achieve much.


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## ozbound12 (Mar 23, 2012)

GBTUSA said:


> Why don't go on a Visitor visa, stay there for a month or two and explore your options? sitting here in the US with 15 hr time difference you won't be able to achieve much.


I don't see how that would help the OP out at all.


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## GBTUSA (Oct 10, 2013)

cookiesinthedark said:


> thanks. I'll just keep trying.
> 
> I have epilepsy that has been very unpredictable and severe in the past (brain surgery, hospitalizations, many medications including one that caused permanent vision and endocrine problems). However, due to a special ketogenic diet it's been very well controlled with little medication for 1.5 years.
> 
> The ironic part is that the job I have lined up in Australia is a postdoctoral research position in which I'll be studying epilepsy.


Any luck with your Insurance hunting?


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## daaxix (May 14, 2015)

GBTUSA said:


> Any luck with your Insurance hunting?


Interestingly enough, I am almost in the exact same situation, postdoctoral offer (in engineering) in Australia. 

Did the OP ever resolve the healthcare issue, or did they have to turn down the postdoc?

I have a chronic back issue, it hasn't been all that costly, but is a pre-existing condition.

I find it very disappointing that Australia is making it very difficult for highly educated and valuable people to visit and work there with the private health cover problems.

At least in the US, a postdoc receives the same private healthcare coverage as any other employee, in Australia we are at a huge disadvantage because we have to pay healthcare out of pocket, childcare out of pocket, etc. 

The system is good for citizens, but very anti-competitive for temporary residents or people attempting to become permanent residents.


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