Hospital costs - don't get caught out by surprise

Have you got a hospital visit coming up?

While your hospital cover will help look after the worst of the expenses, what about the rest? We’ve all heard stories of people paying over the odds for care they thought was covered. Out-of-pocket medical costs that Medicare and the health fund don’t cover.

What are out-of-pocket medical costs?

The government sets out a list of recommended fees all for medical services payable by Medicare. This is called the Medical Benefits Schedule (MBS). As your insurer, we pay 25% of MBS recommended fees (as well as your private hospital room and other costs) and Medicare pays the rest. However, the medical providers involved in your hospital care can charge what they believe is a fair price for their services. Anything over the MBS fee is your out-of-pocket cost.

How can make sure you’re not caught out?

Firstly, you can ask your GP to help. They could refer you to a specialist who charges moderate fees or has agreements with health funds to keep costs for patients down. We call this Access Gap Cover and you can read more about it here. The Healthshare database on that page lets you find participating specialists by name or specialty and location. And your GP has access to this so ask them to check before making the referral.

Next, before agreeing to any treatment, you're entitled to know what you’ll need to pay upfront and any out-of-pocket costs. Ask the treating specialist and anyone else involved in your care to provide this in writing before you give the go-ahead. We call this informed financial consent.

Finally, you can always talk to us. We’ll let you know what your health insurance will cover and any other costs you can expect (like your excess if you have one). We can also give you a heads-up about the other benefits and programs you can access through your membership that can help get you back on your feet as soon as possible.