Section 2: Planning a hospital visit? Here’s what you need to know

There’s nothing more personal than your health, and when it’s time to go to hospital, where you are treated can make a big difference to your experience… so, do you go Private or Public?

One of the biggest advantages of electing to be a private patient for your admission is the choice it gives you… you get to choose the Doctor that treats you and where and when you have your treatment, which also means skipping the often very lengthy waiting lists of the public system.

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.

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.

Why do public hospitals ask members if they would like to use their private hospital cover? Public hospitals ask patients if they would like to be admitted as a private patient because they are paid at a higher rate for the admission when they bill a private health fund, compared to what they would receive from Medicare and the Government for the same public admission.

But will I receive better treatment if I am a private patient? No. You’ll still receive the same treatment, you’ll get a private room if one is available, although it’s likely you’ll be in a shared ward. The time you’ll wait to receive treatment will be that same as if you were to be a public patient, as priority is given based on medical need.

Are there costs involved for me if I use my private cover in a public hospital? Yes, it’s likely that by using your private cover you’ll have to pay your hospital excess (where one applies to your cover). Check out Section 2.1 for more information on being a private patient vs a public patient.

How does it work if I’m admitted as a public patient? By electing to be a public patient in a public hospital, Medicare will fund your admission – putting less pressure on the premiums Phoenix Health charges it’s members; plus you’ll also not have any out-of-pocket expenses to pay towards your admission.

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) See 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.

As soon as you know you need to go to hospital, give us a call on 1800 028 817 and we can help you navigate your upcoming admission – there’s a lot of information and we’re here to help you!

When you get in touch we’ll:

• check to make sure your hospital policy includes cover for the treatment you require
• make sure you’ve served any relevant waiting periods
• tell you if you’ll have an excess to pay towards your hospital stay
• let you know what to ask you specialist, so you’ll have all the information you need
• walk you through how the claiming process will work, what you can (and can’t) claim for and how to submit any claims
• inform you of any Health Support Programs that are available to support you through your admission and or recovery

It’s our job to make your health insurance and hospital admission as easy as possible, so get in touch if you ever have any questions!

Yes, you can choose your own Private Hospital! Phoenix Health has agreements with over 550 hospitals around Australia – so as long as your preferred hospital is on our list, you’ll be covered. It’s easy to check if the hospital of your choice is an Agreement Hospital: Click Here.

Yes, having the choice of who treats you is one of the biggest advantages of holding Private Health Insurance – after all it’s who you’re trusting with your health.

But how do you choose your Specialist? Your GP may recommend one, maybe a friend has recommended someone, or you’ve found a Specialist through your own research. If you’re still looking, you can use our Find a Provider tool to find a Specialist in your local area – Click Here.

You’ll be able to see if the Specialist uses Access Gap Cover – which can reduce some of your out-of-pocket expenses for your surgery. See Section 3.3 for more information.

One thing to keep in mind is most private Specialists work out of certain hospitals, so you’ll need to have a discussion with them about where they practice and if it’s the hospital you’ve chosen.

So that you are able to have all the information you need, so you can make the right decisions for yourself, and so that your hospital claiming experience is as smooth as possible, ask your Specialist these questions:

1. What item numbers will you be using for my procedure?
2. Will you participate in Access Gap for my procedure?
3. Will any other Specialists – like the anaesthetist or assistant surgeon etc – participate in Access Gap for my procedure? If unsure, can I have their contact details so I can get this information?
4. Can you provide me with a full breakdown of fees (also known as Informed Financial Consent) for my treatment?
5. If I need a Medical Device or Human Tissue product, what will my out-of-pocket expenses be?
6. Will I need any other diagnostic tests before my hospital admission?

You can find these questions along with more tips in our downloadable Going to Hospital guide here.

There’s so much to think about when you’re planning to go to hospital… to help make life that little bit easier, we’ve put together the following list of things to remember to pack:

• Your Medicare card
• Your Phoenix Health member card
• Your medications – in their original containers if possible – nursing staff will ask you for them when you’re admitted, so they can give them to you during your stay
• Any x-rays or results from scans you’ve had prior to admission
• Any paperwork the hospital may have given you to complete
• Your glasses
• Toiletries
• Mobile phone and charger
• Wear comfortable clothes and shoes
• Any other personal items to keep you entertained

You can find this checklist along with more tips in our downloadable Going to Hospital guide.