Phoenix Health Fund Private Patient

In some circumstances, like an emergency, we may find ourselves admitted to a public hospital. At Phoenix Health, we understand a hospital admission can be distressing enough, so we’ve answered some common questions about your rights as a private patient in a public hospital.

Am I covered in a public hospital?

Yes and No. If you have private hospital cover with Phoenix Health and have served all relevant waiting periods, the cost of your accommodation and in-patient services where a Medicare benefit is payable are covered.

However, whether you are covered for the particular treatment you require will depend on the level of cover you have (regardless of whether you are at a private or public hospital). For example, benefits for heart treatment aren’t included with Bronze Starter Hospital Cover but are included with Top Gold Hospital Cover.

For more information on what’s included on your level of hospital cover, see your individual cover information sheet or contact us.

Do I have to use my private hospital insurance?

No. It’s your choice how you wish to be treated. There can be benefits to being admitted as a private patient, for example where available your own room and choice of doctor, but at the end of the day if you choose to be treated as a public patient, a public hospital cannot force or coerce you to use your cover.

Will I have to pay to use my private hospital cover?

Possibly. You may have out-of-pocket costs in the following situations:

  • If you are not covered for the services or treatment you receive,
  • If your private hospital cover has an excess, or
  • If your doctor charges above the Medicare Scheduled Fee and does not participate in the Access Gap Scheme. Find out more about this here.

To minimise any unexpected out-of-pocket costs, contact us before making your choice.

How do I know my choice is protected?

The Private Patients Hospital Charter explains your rights and responsibilities as a private patient in a public hospital and can be viewed here.

In addition, under the National Health Reform Agreement, you are given the choice to decide without being pressured by hospital employees.

What questions should I ask the hospital?

When considering your decision, we recommend asking hospital staff the following:

  • Will I have out-of-pocket costs or invoices?
  • Do I get to choose which doctor treats me?
  • Can you guarantee a private room?
  • What are the benefits of using my private hospital cover?

Where can I find help?

If you have questions or concerns over pressure from a public hospital or your admission, the Phoenix Health Team are available to help Monday to Friday 8.30am to 5.00pm on 1800 028 817. Outside of these hours, feel free to email us at enquiries@phoenixhealthfund.com.au and a member of our team will contact you as soon as possible.

Planning a hospital admission?

We recommend contacting the Phoenix Health Team before any planned hospital admission so we can confirm your level of cover, help you minimise any out-of-pocket expenses and even help you navigate the paperwork required for your admission.