Inpatient/outpatient

You become an ‘inpatient’ when you are admitted to a hospital for treatment. You’re an ‘outpatient’ if you receive medical services without being admitted into hospital, including specialist appointments, post-surgical follow-up consultations, prenatal visits, diagnostic imaging, pathology, or emergency triage.

Hospital benefits only apply for medically necessary inpatient treatment as determined by law. For medical services not related to inpatient treatments (outpatient treatment), Medicare will cover 85% of the Medicare Benefits Schedule fee. The law does not allow for any benefit to be paid by health insurance.