Posted 28 May 2018
Article – going to hospital
- Happy members that stay
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Going to hospital as a private patient? Here's how you can save.
Most out-of-pocket costs paid by private patients are for surgeon and specialist fees charged above the Medicare Benefits Schedule fee (Medicare’s standard fee for all medical and hospital charges).
It’s your right to have a clear picture upfront of any extra money you may have to pay when you go to hospital.
By knowing the questions to ask your GP, specialists and us, you can find out how to minimise on surgeon and specialist fees and determine upfront what you will pay out of your own pocket (also known as a ‘gap’ payment).
And remember, a higher fee does not guarantee better quality of care.
If your GP has referred you to a specialist:
- Don’t be afraid to ask why they’ve referred you to a particular specialist.
Is it because they participate in a no- or known- gap scheme like Health Partners Access Gap or because they’ve had positive feedback from other patients?
- Ask if there are likely to be any out-of-pocket costs with the specialists they refer you to.
- Ask them to recommend at least two or three (or more). It’s your right to seek opinions and compare costs for yourself.
- Perhaps you’d prefer an open referral?
This gives you the opportunity to transfer the referral to a specialist that you prefer (so long as they’re in the same speciality field). And remember, with our Doctor Search tool you can see if your specialist has used our Access Gap Scheme in the past.
Specialist fees vary significantly so it pays to ask these questions:
- What is the cost of my treatment?
Ask them to provide a breakdown of the costs and get them to explain any items you don’t understand.
- Will I have a gap to pay? If so, how much will it be?
You can ask for this in writing – it’s called ‘Informed Financial Consent’.
- Will you participate in Health Partners Access Gap Scheme?
This is an agreement we have with participating specialists to limit your medical expenses. It ensures that when you’re treated in hospital, you will either have no gap to pay, or know your exact gap before treatment. Use our Doctor Search to see if your specialist has used our Access Gap Scheme in the past. Your specialist can decide on a patient-by-patient basis if they’d like to participate in Access Gap.
- Are there any other doctors involved in my treatment, such as assisting doctors or anaesthetists? If so, how much will they charge and will they participate in Health Partners Access Gap Scheme.
- Can you reduce your fees?
Surgeons and specialists may reduce their fees if affordability is an issue.
Here are some other questions you may want to ask us:
- What is my excess going to be?
An excess is the amount that you agree to pay towards your hospital accommodation and is a one-off fee per person per rolling year (that is, 12 consecutive months).
- Will I have a co-payment to pay?
A co-payment is a daily amount that you agree to pay towards your hospital accommodation and is applicable to some of our covers.
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