Accidents

When it comes to Private Health Insurance, an accident is an injury that occurred unintentionally or unexpectedly that requires immediate treatment by a Doctor at a hospital. An accident can’t be attributed to medical causes.

Accident Cover is there for when a member is hospitalised as the result of an accident and they’re within waiting periods for hospital cover, or hold a level of hospital cover that has an exclusion for the treatment they need – Phoenix Health will waive the waiting period and pay benefits towards the private hospital admission for the treatment of that condition.

For Accident Cover benefits to be assessed, the member must report to an emergency facility within 24 hours of the injury and a Doctor’s report of this visit must be submitted to Phoenix Health along with any other supporting documentation as requested. All treatment relating to the injury must be initiated within 30 days and completed within 90 days of the accident.

Contact the Phoenix Health Team on 1800 028 817 as soon as you are able, and we can guide you through the Accident Cover claiming process.

Accident Cover cannot be used where:

• the member is admitted into a public hospital for treatment after an accident
• the accident can be related back to a pre-existing medical condition, pregnancy, drug and alcohol use, illegal activities or any condition resulting from a surgical procedure
• the treatment is claimable through compensation and damages or anther third-party insurance policy
• the accident occurred outside of Australia.

In the case of an accident, the first step is to make sure everyone is safe, then to call 000 for an ambulance or go to a hospital emergency department within 24 hours of your accident.

We ask that you contact Phoenix Health as soon as you are able to so that we are able to talk you through your options and the Accident Cover process!

At Phoenix Health, on all of our hospital covers, we provide unlimited cover for all medically necessary emergency and non-emergency ambulance treatment and transport across Australia: road, sea and air – because we want you to have peace of mind that you’re covered when you need it.

What is emergency ambulance?
An emergency ambulance service is when an ambulance is called to a medical emergency, unplanned illness or injury, accident or incident, where medical care and transport is believed to be urgently required.

What is non-emergency ambulance?
A non-emergency ambulance service is when an ambulance is called to a medical emergency, unplanned illness or injury, accident or incident, where medical care can be provided at the scene by the Ambulance officers, or when transport is required, but it is not an emergency.

Does Ambulance have a waiting period?
Ambulance cover only has a 1 day waiting period, so you can feel confident knowing we’ve got you covered!

What if I receive an ambulance bill?
In an emergency there may not be time to give your Phoenix Health details, so if you receive a bill and it’s claimable, send it into us as you would any other claim – we’ll process your claim and generally pay the Ambulance provider directly.

It’s important to know, that where an ambulance service is claimable through another source, including a state ambulance subscription, your claim should be made with them in the first instance.

Fees and charges in an emergency department
If you are taken to a public hospital emergency facility and you’re eligible for Medicare benefits, then you shouldn’t see any bills from your trip to the emergency department and will generally not experience any out-of-pocket costs.

There may be times when you elect to attend a private hospital emergency facility for treatment – you may be able to request that the ambulance take you or you arrive by private transport. While you may not wait as long to be treated in a private emergency facility, you need to be aware of the out-of-pocket costs that you may experience.

Private emergency departments often charge a facility fee which is payable directly to the hospital; this is not claimable through private health insurance but in some cases you may be able to claim a portion through Medicare. Any treatment you receive in the emergency department is an out-patient treatment and as such you will only be able to claim a portion through Medicare. If you are then admitted into hospital as an in-patient for further treatment, your Phoenix Health cover will kick in.

Fees and charges if you’re admitted into hospital after an accident
The bills for your hospital accommodation and theatre fees will come directly to us, you won’t see those. Any others you should take to Medicare first. If you have an excess on your hospital cover, you will still be required to pay this.

If you are unsure about a bill or invoice you have received, just give us a call we’ll be happy to help.

Ambulance
If an ambulance was called to treat you, your bill for this service may come straight to Phoenix Health, however there is a chance it may be sent to you. As benefits are available for medically necessary emergency and non-emergency ambulance under Phoenix Health hospital cover, if you receive a bill and it’s claimable, send it into us as you would any other claim for us to process.

It’s important to know, that where an ambulance service is claimable through another source, including a state ambulance subscription, your claim should be made with them in the first instance.

Discharge Medications
When you leave hospital after your procedure, often you’ll be given discharge medications to continue your treatment at home. There is no benefit payable on discharge medication, so you won’t be able to claim this on your hospital.

If you hold an extras cover you can potentially claim a portion of your discharge medications. We can check this for you, give us a call.

Post-op Doctors Appointments
Once you’ve left hospital, it’s important to know that any follow up appointments you may have with your specialists are considered an out-patient service and are not claimable through your private health insurance -you should be able to claim a portion of this appointment through Medicare though.

Need assistance post hospital admission? We offer before, during and after hospital assistance, mental health and chronic disease management programs – to give you that extra support to get you through your hospital admission. To find out more or to see if you qualify for assistance give us a buzz and talk to a Phoenix Health Team Member.

As your personal health insurer we’re here to provide you with support when you need it the most. From having a baby, to weight management and diabetes education, supporting your mental health and joint care; our programs are designed to support you through whatever life throws at you! Provided by trained health professionals and often in conjunction with your treating Doctors, our Health Support Programs are available at no extra cost with your hospital cover.

Learn more about our range of Health Support Programs and how they can help you, here.

Taking a little extra care of your health right after you’ve had surgery is so important, and while you can’t claim for outpatient Specialist visits, there are other ways your health insurance has your back.

Have Extras Cover? If you hold Phoenix Health Extras Cover you may be able to claim a benefit towards allied health services that will help you in your recovery, like Physiotherapy, Remedial Massage, Occupational Therapy and Chiropractic, as well as Aids to Recovery for items like toilet seat raisers, pregnancy recovery pants and even wigs after cancer treatment and bras after mastectomy. You should refer to your Product Information Sheet for your level of cover or get in touch with a Phoenix Health team member to check your eligibility and find out how to claim.