Your private health insurance guide to hospital
For many a hospital admission is a process that they've never gone through before, and there quite a few steps to take between your specialist appointment, undergoing the procedure and being discharged. If it’s unfamiliar territory, don't be afraid to ask your specialist/doctor, your health insurer and the hospital questions – in fact, we recommend that you do.
This guide explains your rights and responsibilities as a private patient entering hospital – what you should know and what you should ask.
Heading to Hospital
Most hospitals ask you to limit your items to a small bag about the size of an airline carry-on
1. Paperwork on Arrival
• Medicare Card
• Private health insurance details
• Your GP details and surgeons name
• Emergency contact names/numbers for the hospital records
• List of illnesses, previous surgeries, and allergies
2. All current medicines
Pack the medicines you currently take. These include prescription medicines bought at a pharmacy, supermarket or health food shop, as well as vitamins and herbal medicines. Include the dose, time of day, and reason for the medication. The hospital will want to gauge what potential conflict you face if you are to be given added medications, or if dosage rates are to be altered.
3. Health Aids
If you use things like hearing aids or glasses in your daily life, take them with you.
4. Personal Items
• Toothbrush
• Toothpaste
• Mouthwash
• Facewash
• Brush or comb
• Other personal hygiene items e.g. deodorant
5. Sleepwear & daywear
• Loose, sensible easy in-and-out clothes are best. Wear something comfortable when going into hospital and have another outfit ready for going home. The design of this will depend on what you are having done, stitches or mobility of dressing after surgery.
• Socks, underwear, and slippers or comfortable footwear.
6. Magazines and books, notepad and pen
To keep you busy in your recovery stay.
7. Phone and/or tablet and chargers
To keep in touch with family and friends when in hospital.
8. Spare plastic bags
Something to put your dirty laundry in and keep it separate from your clean clothes is not usually top of mind – until you forget to pack it.
- Treatment information – Your doctor should clearly explain your diagnosis, the treatment options and any associated risks, and the costs of treatment. They should also get your permission before undertaking any treatment unless it’s a situation where that’s not possible, such as an emergency.
- Informed financial consent – Your doctor and health service providers should inform you of the costs of your proposed treatment and any potential out of pocket expenses, then get your consent in writing before you undergo treatment.
- Other medical opinions – You have the right to ask to be referred for other medical opinions but this might incur additional costs that may not be covered by either Medicare or your private health insurance.
- Get advice about costs – Even though you have private health cover you should ask your doctor, your private health insurer and the hospital about the expected costs of your treatment. In some cases your insurer will cover all of your hospital treatment and medical bills, but you have to pay a gap, as well as an excess or co-payment. The only way to be clear about what it’ll cost you, is to ask prior to treatment.
- Provide accurate information – To help those treating you to provide the best of care and make the best decisions for your health, always be sure you give accurate information. This means letting your doctor or specialist know about any allergies, family and medical history, any psychological or mental health issues you have, any other treatment you are undergoing, and any medications you are on, whether prescribed by a doctor or not.
- Confidentiality and access to your medical records – Your personal details are strictly confidential but there may be times when information about you needs to be given to another health worker who is looking after you, or for legal reasons. You’ll need to sign a form to agree to your private health insurer being able to access certain information to allow payments to be made for your treatment.
- Under the Freedom of Information Act you are allowed to see and obtain a copy of your medical records kept in a public hospital, whilst the National Privacy Principles give you a general right to see and obtain your personal information kept by private medical providers.
- Visitors – Your hospital will have visiting hours for family and friends during your stay. This includes family access and who is considered family, arrangements for parents or guardians if a child is the patient, and when friends can visit.
- Respect and dignity – You can expect to be treated with courtesy and for your cultural, religious and ethnic practices and beliefs to be respected. It is your responsibility to treat your health care workers and other patients with courtesy and respect.
- Nurses and allied health professionals – Nurses and allied health professionals are an important part of your treatment and care in hospital. They should always identify themselves and you should feel that you’re able to talk about issues to do with your treatment or hospital experience with them.
- Be involved with decisions about your care – Before you leave hospital you should have a conversation about your ongoing care once you leave. This includes more information about medical care, medications, home nursing or anything else you might need once you’re back at home.
- Long stay patients – If you’re in hospital for a long stay, you might become a nursing home type patient. Check with your hospital and private health insurer about what this means for you.
- Comments or complaints – You should always raise any concerns you have about your hospital treatment with the staff looking after you or hospital administration. If you feel you need to go further, look up your State or Territory’s independent organisation that deals with health services complaints.
- If your complaint is about your private health insurance, talk to your insurer in the first instance. The next step is to free call the Private Health Insurance Ombudsman on 1800 640 695.
Important information
What's not covered?
Non-exhaustive list
- Services incurred before waiting periods have been served.
- Treatment for which Medicare does not pay a benefit, including cosmetic surgery. (Some benefits may be payable for hospital treatment following this surgery. Please call us for more details.)
- Services that are provided outside of the Commonwealth of Australia.
- Services where an entitlement exists or may exist under any compensation, sports club or third party insurance.
- A claim for a service that is submitted more than two years after the date of service.
- Outpatient services, unless there is an agreement between Emergency Services Health and the hospital.
- Pharmaceuticals not related to the reason for hospitalisation or not covered under the agreement with the hospital or provided on discharge.
- Exceptional high-cost drugs where no or limited benefits are paid.
- Prostheses items that are not included on the Federal Government approved list.
- Charges greater than the benefit defined in the Federal Government’s Prostheses List.
- Personal and take-home items, e.g. newspapers, toiletries, television, hairdressing, manicure, etc.
- Treatment provided to a person in a private hospital emergency department.
- Aged care and accommodation in an aged care facility.
- If you’re in hospital for more than 35 consecutive days and not classified as an acute care patient, your benefits will significantly reduce.
- Benefits for ambulance services covered by a third party arrangement such as a State/Territory transportation scheme.
* This provides a general description of what is not covered. These are not “excluded or restricted” hospital treatments or services. Should you require information about a particular treatment or benefit please call us on 1300 703 703.
You may have heard private health funds refer to agreement hospitals, contracted hospitals or even members hospitals. These are hospitals that private health funds have contracts with and generally, for members to receive their full benefit entitlement, they need to go to these hospitals.
Emergency Services Health has contracts with the majority of Australia's private hospitals. These contracts cover the vast majority of hospital admissions for our members and help keep the cost of your hospital insurance down. These arrangements ensure that an agreed schedule of fees (including in-patient accommodation, theatre, and special unit accommodation fees as appropriate) is charged by the hospital and paid by Emergency Services Health on the member's behalf.
However, with Emergency Services Health, if you need to be admitted to a non-contracted hospital, we'll still provide you with full cover for recognised services you receive in that hospital. So you still get to choose the hospital for the treatment you require with total peace of mind.
Naturally, we'd prefer members to use one of our contracted hospitals, but as location and choice of specialist can sometimes limit your options, we'll leave that choice to you. If for any reason we cease to recognise a hospital for full benefits, we will provide details of that hospital(s) on our website.
In the unlikely event that we cease to recognise a hospital for full benefits, Emergency Services Health will advise members likely to be affected and publish the information on our website.
Regrettably, following negotiations, Emergency Services Health through the AHSA have been unable to reach an agreement with Toowong Private Hospital on what we believe are fair fees. Reaching agreement on the level of fees they charge and we cover is important as it avoids unnecessary pressure being placed on your health fund premiums.
Toowong Private Hospital have now terminated our agreement effective midnight 24 August 2017. From this date, new and increased fees may be charged by them for the hospital services they provide. These fees are likely to be higher than what Police Health recognise for benefit payment purposes, resulting in a portion of their fees not being covered by us and being borne directly by you.
Transitional arrangements are in place to provide protection for our members at this hospital if before 25 August 2017:
- Treatment has commenced
- Treatment has been pre-booked and will be performed prior to 24 February 2018
- A course of treatment has commenced (includes treatments for up to 6 months)
In these circumstances the hospital will bill patients in line with the existing agreement and Police Health will pay its benefits.
A list of possible alternate hospital facilities offering mental health programs and care nearby can be found below. These are all hospitals with whom we have agreements over the fees they charge which will generally be covered by Emergency Services Health.
- Brisbane Private - Brisbane
- Belmont Private - Carina
- New Farm Clinic - New Farm
- North West Private Hospital - Everton Park
- Pine Rivers Private Hospital - Strathpine
If you require or a re-planning treatment at Toowong Private Hospital please contact us to discuss how this could affect you. Likewise, if you have any questions regarding your hospital cover, please contact us on 1300 703 703.
Questions to ask
Important questions to ask your treating doctor or specialist before your stay in hospital.
- Get written confirmation of the fee and how much you can expect to have covered by Medicare and/or your private health insurance.
- Whether they're covered by your health insurer's gap payment arrangements and if not, how much you're likely to have to pay.
- Who else will be involved in your treatment (for example, the anaesthetist), how you can get information about their fees, and whether they'll be covered by your private health insurance?
- To estimate any other costs associated with your treatment that might not be covered Medicare or private health, such as diagnoistic tests or pharmaceutical drugs.
- If you're having a surgically implanted device or prosthesis and how much this might cost you out of pocket.
Important questions to ask your health insurer before your stay in hospital.
- Is the treatment you're having covered by your private health insurance, and are there any exclusions or waiting periods that apply for you with the level of cover you have? If you're having a baby, contact your health insurer as early as possible in the pregnancy to find out the rules for obstetrics and newborn babies.
- Do any gap payments apply, and if so, how much will you need to pay?
- Will you have to pay an excess or co-payment, and if so, how much?
- What's the level of hospital accommodation covered by your policy? Some policies only cover you if you're a private patient in a public hospital.
- Is there an agreement in the place between your insurer and the hospital you're going to?
- Do you need to pay extra for surgically implanted devices or prostheses?
Important questions to ask your hospital before your stay.
- Do they have an agreement with your private health insurer?
- Will you have to pay any out of pocket expenses for your hospital accommodation?
- Will there be any additional hospital charges not covered by your private health insurance such as TV hire or telephone calls?
Need to speak with us?
We understand that private health insurance can be confusing, and we're here to help.
To speak with one of our member services team about an upcoming or possible hospital stay, click below.
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