Outpatient Procedures

An outpatient procedure is any sort of medical treatment done outside of a hospital admission – this could be in a doctor’s surgery or specialist’s clinic and can include things like x-rays, injections and skin treatments.

Even if you go to a specialist’s rooms in a hospital for a consult or treatment, if you are not admitted into the hospital, it will be considered an out-patient procedure.

In-patient services are received whilst you’re admitted into hospital.

If you’re admitted as a private patient, as long as the treatment you receive is included with your Hospital Cover, then you will be able to claim up to the Medicare Benefit Schedule Fee (MBS). Section 3.1

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

Any treatments you receive as an out-patient are not claimable under private health. Out-patient services are generally claimable through Medicare and can include medical procedures done in a Doctor’s rooms, pathology tests and scans.

So that you are able to have all the information you need, so you can make the right decisions for yourself, we recommend that you ask your Specialist these questions:

• What item numbers will you be using for my procedure?
• Can you provide me with a full breakdown of fees (also known as Informed Financial Consent) for my treatment?
• If I need a Medical Device or Human Tissue product, what will my out-of-pocket expenses be?
• Will I need any other diagnostic tests?

As there are no private health benefits available towards out-patient procedures, depending on your Doctor, you may experience some out-of-pocket fees.

For all medical services recognised by Medicare, there is a Medicare Benefit Schedule Fee (MBS) which is a guideline fee the Government have set for doctors to charge – think of it like a recommended retail price; and Doctors can and do charge above this Scheduled Fee. If you receive a bill for your treatment, get in touch with Medicare to discuss whether you can claim it or not.

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 when you need it the most. 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 a procedure 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.