Public, private and the broadening grey chasm in Australia’s medical system


    By Derek Green

    What follows is the sad, frustrating tale of a layman navigating the medical system in search of the truth – whilst trying really hard to submit a claim to someone, anyone who would take it.

    OK, so this is not an investigative journalistic piece with months of sleuthing, I’m just some schlep like you who pays their taxes, is subjected to a bit of poking and prodding from time to time, and expects the rest of the system to just work – I’m way too lazy for a deep dive. This all may sound like I’m just dipping my toe in the water and then having a whinge, but I do have lived experience. As a SOP (Super Organised Person) I have a filing cabinet with paper documents, arranged in order of importance/need-to-access. ‘Career as a rock legend’ has gradually receded to the cobwebbed rear, but sadly, ‘Medical’ has made its way to the front, just ahead of the recently usurped king of the Manilla folders ‘Overseas Travel.’ I did have my moment in the medical system and everything thankfully worked smoothly, and I was cared for by highly efficient and competent people. The reason I was there may be triggering, but gratitude is all I feel.

    Meanwhile back at the ranch…

    Me: Hi I’ve been referred by my GP for a procedure.

    Medical Service Provider: OK we can book you in next Thursday! But I have to tell you now you can’t claim it on insurance or Medicare.

    Me (thinks) What a strange response, but whatever. 

    Me: Oh, OK thanks, see you then!

    While waiting for this appointment I logged into my private health insurance website to see if I could find anything about the coverage for this procedure, and noticed there was already a claim against my policy by Medical Service Provider, made without my knowledge. 

    Me (thinks) But if the procedure isn’t claimable, how come they have made a claim? Better call my private insurance people…

    Me: Oh hi I’m getting a procedure next week at Medical Service Provider but they have said it’s not claimable, yet I can already see a claim against my account.

    Private Health Insurance Provider: Can you tell us the Medicare item number of the procedure, and I’ll look it up.

    Me: I have no idea, there’s only the procedure name but no item number on the form. 

    Private Health Insurance Provider: OK so what are you having done?

    Me: It’s just a simple double osteo-craniotopic-keratoproscopy*

    Private Health Insurance Provider: Hmm, OK, according to my screen that IS actually covered. I suggest you ask about that on the day.

    The day of the procedure came, and the procedure was complete, with all my body parts still in their usual places. As I PAID IN FULL to the tune of $500, I asked again about claiming it.

    Me: So my medical insurance people say this IS actually claimable?

    Medical Service Provider: No! They are wrong. Please tap here, thank you, bye bye!

    I left feeling sceptical, and slightly like the meat in some sort of medical-industry sandwich. Later I called my private health cover again.

    Me: So Medical Service Provider insisted that my procedure couldn’t be claimed.

    Private Health Insurance Provider: That is strange, the claim you saw against your account with us which was entered by Medical Service Provider is gone, there’s nothing there.

    Me: Nothing?

    Private Health Insurance Provider: Nudda! Nein! Niet! All goneski! But I think we can still pay out against your policy, you’ll just need to do a claim with Medicare first.

    Me: First? But why can’t you just pay me back if it’s claimable?

    Private Health Insurance Provider: Because it needs to be rejected by Medicare first, so that you can get a Form Name I Can’t Remember.

    Me: So if I can get you the Form Name I Can’t Remember, you can pay?

    Private Health Insurance Provider: Yes! Form Name I Can’t Remember is all you need! Have a nice day!

    So off I went to the Medicare website to submit my claim. Only, it’s not Medicare anymore, it’s MyGov, and I discovered I’d need a username, password, email address, and to then download an app so I could provide myself with 2-factor authentication. Thinking that just going to a Medicare shopfront and sitting down with a nice person who could help me work it all out over a cup of tea would be easier and a bit more sensible, I soon discovered that what I needed was actually now called Services Australia, AKA Centrelink, as there were no Medicare outlets anymore. They would be able to help me, but I’d need 7 forms of ID, an online account regardless of the fact that I was coming in person, and I’d need to camp out the front overnight in order to get a number that would allow me to be seen within 72 hours.

    Feeling exhausted and highly suspicious of all this, I persevered with the Medicare Online Claim Form option, naturally failing at the first hurdle: ‘Medicare item number’. I had wrongly assumed this would be on my paid invoice provided by Medical Service Provider, so I reluctantly called them and asked for it.

    Medical Service Provider: What do you want that for? I told you, you can’t claim it!

    Me: Yeah I know I can’t claim it, I just thought it might be lucky for this week’s Powerball.

    Medical Service Provider: Oooh, good thinking! OK sure, the number is 24683579

    Back to the Medicare Online Claim Form I went, only to fail at the second hurdle: ‘Service Provider Number.’ Again I called Medical Service Provider, and politely asked for the number. 

    Medical Service Provider: What do you want that for?

    Me: Erm… the other numbers weren’t enough for Powerball, I need more.

    Medical Service Provider: I can’t tell you the number, but it will be on your invoice.

    Me: No, it’s not. Can you email me another invoice, this time with the number on it?

    Medical Service Provider: We only post. I will post it to you soon.

    Two weeks passed. Like a kid waiting for my delivery of Taylor Swift wristbands, I stood by the mailbox every day, and finally armed with the Service Provider Number, returned to the Medicare Online Claim form, only to be rejected again: ‘Service Provider Number Invalid’. 

    Since this ordeal started I had grown two beards, learned rudimentary Swahili, and watched human-kind start new wars, cure cancer, and land on the moon – in terms of time involvement I was fully invested. Undeterred, I rang Medical Service Provider again. By now I’d struck up a rapport with their reception person. We’ll probably catch up again next year for drinks on the anniversary of my double osteo-craniotopic-keratoproscopy.

    Me: Hi, the number you gave me didn’t work.

    Medical Service Provider: We’ve been here 100 years and the number has never changed! Are you stupid? I’ll read it again slowly: D-O-D-G-Y-1-2-3-4

    Me: Yes that’s what I have. Is there no other number you can give me?

    Medical Service Provider: No that’s the number. Thank you, bye!

    The point where 99% of normal, sane people would have given up on their lousy 500 bucks was long gone – this had now become 100% about principle. After calling my friendly Private Health Insurance Provider again and discovering that the provider number must be connected to a living PERSON and not a PLACE, and that this was the reason ‘Dr MedServProv DODGY1234’ was not being accepted by the Medicare Online Claim Form, I decided to find the number of the actual doctor who conducted the procedure, and try and use that in the form. Page 47 of my Google search results finally delivered the coveted details, and I duly completed the form and pressed submit. With hopes of success as high as a worm’s forehead, I settled in for the inevitable 3 month wait and subsequent rejection, as well as preparing myself for the next round of battles with Medical Service Provider, Private Health Insurance Provider, and the recalcitrant Medicare Online Claim Form.

    Two days later my freshly installed MyGov app pinged. I had a new payment – $500 had been sent to my bank account. My mind swirled with questions the cynic in me already knew the answers to. Why had Medical Service Provider obstructed me? Why did I need to make so many phone calls and jump through so many hoops just to try and make a claim? I work in tech, I have a decent grasp of the English language and yet it took so much time and effort to break through the system barriers and clear all the hurdles deftly placed in the name of cost savings. How depressing to think of all the vulnerable people out there who really could have used that cash – the elderly, language or technology challenged. They would have had no hope.

    Not wanting to break my brain further with the intricacies of how vested interests influence power, and seek to profit from all of our most basic human rights, I resolved that, at the very least I was $500 richer, but certainly none the wiser.

    Therapy starts next week. Hopefully it’s claimable. 

    *Obviously I’ve made this procedure up.

    Derek Green
    Derek Green
    I'd rather die wandering than die wondering. Read more of my travel escapades at:

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