Emergency Hospital Visits

An emergency hospital visit is unplanned and usually seeking treatment for a serious accident, illness or injury. You’ll generally present to an emergency department for urgent treatment.

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 the ambulance trip is 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.

In an emergency, whether you go by Ambulance or your own transport the first place you’re likely to go is a hospital emergency department. Most major public hospitals have emergency departments that are open 24 hours to treat serious, urgent and life -threatening issues while there are some bigger private hospitals who also have emergency departments. All emergency departments are considered out-patient facilities – you’re not admitted into the hospital, and as such any treatment you receive is as an out-patient.

Public Hospital Emergency Department
If you’re transported by Ambulance in an emergency, they will more than likely take you to the closest public hospital, public hospital emergency departments are often larger and more equipped with dealing with more serious injuries. The treatment you receive will be covered by Medicare, so you will generally have no out-of-pocket costs.

Private Hospital Emergency Department
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, 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.

It’s important that you know that it’s your right to choose where you’re treated and whether you want to be a private patient in a private hospital, a private patient in a public hospital or a public patient in a public hospital. Just because you hold private hospital cover does not mean you have to be a private patient when you go to a public hospital.

We’ve put together the table below, to help you understand the difference between being a Private or Public patient, so you can make the best decision for you.

In-patient services are received whilst you’re admitted into hospital. Emergency departments are considered out-patient facilities.

If you need to be admitted into the hospital for surgery or further treatment, and elect to be a private-patient, this is where your private hospital cover will kick in and as long as the treatment you receive as an in-patient is included with your Hospital Cover, then you will be able to claim up to the Medicare Benefit Schedule Fee (MBS). (See Section 3.1).

Out-patient services are treatments received outside of a hospital admission.

Emergency departments are considered out-patient facilities and as such any treatments you receive in the emergency room are not claimable under private health. Out-patient services are generally claimable through Medicare.

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

Fees and charges in a private hospital emergency department
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; 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.

Ambulance
If an ambulance was called to treat you in an emergency, 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 the ambulance trip is 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 included in all Phoenix Health hospital covers.

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.