Wagga Calvary and Medibank Private resume health care crisis talks

It comes as the health insurer on Monday made public a list of “adverse events” that will not be covered by the health insurer.

“Calvary and Medibank confirm they have resumed formal contract negotiations, but given the confidential nature of our discussions it would not be appropriate to comment on the specifics of our negotiations,” Calvary national chief Mark Doran and Medibank executive general manager provider networks and integrated care Dr Andrew Wilson said in a joint statement.

Mr Doran and Dr Wilson stated that they have been encouraged by the progress of discussions.

Among the Medibank list of 165 includes 131 types of falls, and wound infections following a procedure, and treatment for post-operative bleeding and bruising. 

A spokesman for Calvary said Medibank cannot penalise Calvary “for any of the 165 ‘so called’ highly preventable adverse effects or for hospital readmissions within 28 days” due to it being mandated in the Private Health Insurance Act under the second tier benefits section.

“Second tier default benefits are defined by law as being the minimum payment a health fund could make for an episode of care,” the spokesman said.

“Simply put, the health fund may reduce the benefits it pays the hospital to a figure that is 85 per cent of the average it pays comparable hospitals for that service.”

The chief of another health provider, Healthscope, told Fairfax  he would happily sign up to a standard of quality patient care criteria proposed by the government, as opposed to the standard that Medibank is trying to push on to hospitals. 

"That list is calling it a mistake when a patient comes in with an infection. That is not a mistake," Mr Cooke said.

Based on information given to Calvary from Medibank Private, the health care provider expects to see a gap of between 10-25 per cent.

Examples include:

Out of pocket costs will vary from different hospitals and will be subject to an independent audit.