Hospital Support

1

Talk with your GP

 2

Check your cover

 3

Visit a specialist

 4

Choose your hospital

 5

Confirm your costs

 6

Prepare for Hospital

 7

While in Hospital

 8

Your recovery

 9

Bills and claiming

Step 9: Bills and claiming

It’s our job to help guide you through the claiming and billing process. We want you to feel comfortable and have a clear understanding of everything you’re being charged for.

Hospital bills

If you’re admitted to a Health Partners Participating Hospital, your bill will be sent directly to us for payment. The only bill you might need to pay is your hospital excess or co-payment, usually done on admission.

If you’re charged other incidental costs such as medications during your hospital say, call us on 1300 113 113 and we’ll check if they’re covered under your Hospital cover.

Medical bills

Access Gap Payments

If your specialist has chosen to participate in Health Partners Access Gap Scheme, you probably won’t need to do a thing.

They’ll send the bill directly to us. Once we’ve paid it, we’ll send you a quarterly statement to let you know what we’ve paid on your behalf. If they charge a gap, you’ll need to pay this directly to them, in most cases before the planned surgery.

Paying an out-out-pocket cost (gap payment)

This means you only need to pay the difference between what your specialist charges and what Medicare and Health Partners covers, rather than the full bill. This is generally paid to your specialist prior to surgery.

Being charged the full amount

If your specialist sends the total bill directly to you, you’ll need to send it to Medicare first. There are two ways you can claim with Medicare:

1. Medicare Two Way Claiming
The easiest way to make a claim is to fill in a Medicare Two Way claim form. Once Medicare has processed the account, they’ll send everything directly to us, so you won’t have to worry about it.

2. Health Partners claiming form with a Medicare benefit statement
Claim with Medicare first using their process. Once you receive your Medicare benefit, you’ll need to send us your original bill, Medicare benefit statement and completed Health Partners claim form.

Tip: If you have an account with Medicare, you can download your Medicare benefit statement from myGov.

How to save on your medical bills

Register for Medicare Safety Net

If you’re needing to see a doctor or have tests frequently, register for the Medicare Safety Net. Once you reach the threshold, you will start receiving a higher Medicare benefit for out-of-hospital costs such as doctors’ visits and diagnostic tests like x-rays and ultrasounds. They will still cost the same, but Medicare will give you a higher benefit back, so you pay less.

Learn other ways to save

How to dispute a medical bill

If your specialist invoice (bill) is excessively higher than your formal quote, we recommend following these 4 steps:

Step 1. Gather information

Review and gather all your information like quotes, dates, correspondences and any other documents you might have. Document as much as you can from your conversations with your specialist.

Step 2. Contact your specialist’s practice

Question why your bill is higher than your agreed quote.

Step 3. Put it in writing

If your specialist can’t explain the increase, you’ll need to formalise your complaint by putting it in writing via email or mail. Summarise what’s happened and briefly state why you’re unable to pay the difference. The Commonwealth Ombudsman also recommends paying some of the bill i.e. what you thought you would pay.

Step 4. Make a formal complaint

If you’re unable to resolve the problem with your specialist, make a formal complaint with the Royal Australasian College of Surgeons (RACS). The RACS will investigate and determine whether the fees charged are excessive and help you seek a resolution.

What Hospital cover pays for

If included in your policy, when you’re admitted to hospital, you’ll be completely covered for:

  • Your hospital accommodation (including registered day facilities)
  • Your theatre, nursing care, labour ward and intensive care fees
  • All PBS prescriptions relating to your admission, while you’re in hospital
  • An extensive range of Government-recognised surgically implanted prostheses

Depending on your level of cover, your Hospital policy will also pay towards:

  • Inpatient medical fees, which include blood tests, scans and recovery equipment
  • Medicare Benefits Schedule (MBS) fees charged by your specialist

What Hospital cover can’t pay for

By law, health insurers can’t pay for:

  • Procedures if you’re are treated in hospital as an outpatient i.e. in emergency or outpatient clinic
  • Specialist gaps or fees that are over and above the Medicare schedule fee for the procedure
  • Outpatient consultations by specialists and GPs.

Call us on 1300 113 113 if you have any questions about your bills or the claiming process.

The information contained here is of a general nature and does not take into account your personal medical situation. The information is not a substitute for independent professional medical advice and is not intended to diagnose, treat, cure or prevent any disease or used for therapeutic purposes. Should you require specific medical information, please seek advice from your healthcare practitioner. Health Partners does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information provided.

On this page:
Hospital bills Medical bills Bill disputes What Hospital cover pays for What Hospital can’t pay for
icon
Your waiting periods switch with you

You won’t need to re-serve equivalent waits

icon
30 day cooling off period

To make sure you’re happy

icon
Not for profit, we’re in it for you

Caring for members’ health for over 80 years

Busy? Get a call back

28/02/2021
28/02/2021
28/02/2021

Thank you for your submission

© Copyright Health Partners. 2021 All Rights Reserved.

Your Health Insurance Partner

Working with Health Partners

site by evolution 7