Call us before visiting your specialist to check what your cover includes and if you have an excess, or any co-payments, restrictions or need to serve waiting periods. You might not know what surgery or treatment you need yet, but it’s best to be prepared. If we can, we’ll also help you:
We’re all about confusion free hospital cover, and that means helping you understand all of the costs that may be associated with a hospital stay.
Below we explain the most common out-of-pocket costs you may have if you go to hospital, they can be largely broken into hospital costs and medical costs.
Depending on your level of cover, you may have chosen for nil excess, or an excess between $250 to $750. This is a set amount outlined on your policy documents and paid directly to the hospital prior to or on your admission. Most Health Partners hospital policies waive the excess for dependants under 25.
You’ll only have to pay your excess amount once in a consecutive 12 month period, and if two people on your policy pay in that time we’ll waive the excess for anyone else on your policy for the remainder of the 12 months.
Some policies have a co-payment, in place of or in addition to an excess that you pay towards your hospital stay. This works as a set daily amount outlined on your policy documents and is paid directly to the hospital. It’s capped per person, per membership so you know the maximum that may apply in a consecutive 12 month period.
Medicare sets a standard fee for all medical and hospital procedure item numbers, called the Medicare Benefits Schedule (MBS) fee. When you’re admitted as a private patient, Medicare will reimburse 75% of the scheduled MBS item fee they have set for each procedure, and Private Health Insurance, by law, can only pay the remaining 25%.
In Australia, specialists are able to set their own fees, and these fees can vary significantly. When a specialist sets their fee higher than the MBS fee, it creates an out-of-pocket cost, which you will need to pay.
When it comes to planning your hospital procedure, there are two terms that you’ll hear often – ‘inpatient’ and ‘outpatient’. Knowing the difference between the two will help you understand if you’ll be covered by Medicare, your private health insurance, or whether you’ll need to pay for some of the treatment yourself.
An inpatient is when you’ve been formally admitted to a hospital for overnight surgery (like if you need a knee replacement) or day surgery (such as arthroscopies or endoscopies).
You can also be classified as an inpatient if you’re admitted to a registered day clinic by a doctor, and receiving short term medical treatment, like cataract removal, colonoscopies and skin cancer removals.
There are two ways you can be admitted as an inpatient: through an emergency situation or a pre-booked surgery, or treatment by a doctor.
What happens when you visit the emergency department?
You will only be classified as an inpatient if you have been formally admitted to the hospital for medical treatment following your visit to the emergency department.
In private hospitals, an emergency facility fee is charged which is not covered by Medicare, and therefore not private health insurance, regardless of whether you’re admitted for further medical treatment in that hospital. Some hospitals may choose to waive this fee at their discretion.
You’ll be classified as an outpatient if your treatment is provided in a doctor’s surgery, specialist’s clinic, or emergency department (when you haven’t been admitted to hospital).
By law, private health insurers aren’t allowed to cover outpatients consultations or treatments, these include:
If you’re an outpatient, your costs will mainly be covered by Medicare, but if you’re not bulk-billed, you’ll most likely have some out-of-pocket-costs.
If included in your policy, when you’re admitted to an agreement or participating hospital, you’ll be 100% covered for:
Depending on your level of Hospital cover, it will also pay towards:
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.