The simple answer to this question is yes… and no.

Under Medicare, any Australian resident admitted as a public patient in a public hospital is entitled to treatment by a doctor appointed by the hospital, at a time determined by the hospital. Medicare pays for your accommodation, meals, medical and nursing care, theatre and other fees related to your treatment. This means that anyone (including Phoenix members) that choose to be admitted into a public hospital as a public patient (without using their health insurance) receives full coverage from Medicare directly.

With Health Insurers now paying record treatment payments to public hospitals of up to 1 billion dollars collectively last year (as noted by Private Hospitals Association CEO Michael Roff), additional expenses are now being paid by health insurers for treatments that many members could have received free of charge through Medicare.  This has unfortunately directly contributed to increases in contribution to members.

Won’t I get better treatment though if I am admitted as a Private Patient (i.e. electing to use my Private Health Insurance) in a Public Hospital?

If you choose to use your private health insurance when admitted to a public hospital, in most cases this will not grant you any better or special medical treatment.

In public hospitals, private rooms are generally allocated to people who medically need them the most. So while you can request a private room as a private patient, you may not always be allocated one depending on availability. The hospital may also transfer you from a private room to a shared room during your stay if another patient needs the private room more.  You also have the option to use your doctor of choice, should you be admitted privately in a public hospital, however depending on your illness or condition and the size of the hospital, this may be the same doctor who would have been allocated to you by the hospital as a public patient.

It should also be noted that should you elect to use your Health insurance in a public hospital, that there may be costs for you to pay (that would have originally been covered for free under Medicare without the use of your Health Insurance) including excess payments, and additional out of pocket charges that your doctor may charge for your treatment.

So if I have Phoenix cover, don’t I have to use my cover when I go to a Public Hospital?.

Members have the right to use their Health insurance when they see fit.  If you cannot see the value of using your health insurance in a public hospital, you are well within your rights to not use your Health Insurance and simply be admitted as a public patient.

So when should I use my health insurance in a Public hospital? 

Because health Insurers are unnecessarily paying more than ever for members using their health insurance for public hospital expenses, where no additional benefit it given over public patients, members should consider whether it’s worth using their cover by asking the hospital a number of questions when being admitted.  The answers that you receive from these questions should then give you an indication as to whether there is benefit for you to use your insurance or not.

  • How will I benefit from electing to be a Private Phoenix member in this public hospital?  Is there any difference given to me as a private patient?
  • Can you guarantee me a private room for the length of my stay?
  • Can I choose my own doctor?

Why have we brought this up?

With Health Insurance increases becoming an unfortunate reality, particularly in the last 5 years, Phoenix Health Fund is looking at ways in which to improve services, without the need to continually increase prices. With feedback from members saying that public hospitals have been aggressively persuading Health Insurance members to use their health insurance in public hospitals, but members then not seeing any additional benefit in doing so, the fund wants all members to be well aware of their rights as a member.

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