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.
What does medically necessary mean?
Medically necessary means on-site treatment or transport to the closest hospital or emergency department for treatment of an acute medical condition or accident.
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.
| Public Patient in a Public Hospital | Private Patient in a Public Hospital |
|
|---|---|---|
| Is there a waiting period? | No. | Yes – 12 months for any pre-existing conditions and 2 months for all other conditions. Learn more about waiting periods. |
| Can I choose my hospital in an emergency? | This will depend on your location and the treatment you require. Often an Ambulance will take you to the closest public hospital in an emergency. | |
| Can I choose my Specialist? | No. | |
| Will I get a private room | Only if one is available to you, although it’s likely you’ll be in a shared ward. | Yes, if one is available, but there’s likely to be out-of-pocket expenses. |
| Will I have to pay an excess? | No. | Yes. |
| Will I have to pay for my hospital accommodation? | No. | You will potentially have out-of-pockets. You are eligible for accommodation benefits applicable to your state |
| Will I have any additional fees? | Likely none. | Doctors’ fees above the Medicare Benefits Schedule (MBS) fee. Learn more about hospital doctors’ fees. Your hospital excess (if you have one), personal items like newspapers and TV, and pharmaceuticals provided on discharge will be payable by you. |
Feeling pressured in a public hospital to be admitted as a private patient?
Sometimes members have felt like they were pressured by a public hospital to use their private cover for their admissions. You need to know that it is your choice whether you want to stay a public patient, or if you want to elect to use your private cover. You are not required to provide the hospital with your private health insurance information. If you are ever unsure, get in touch with the Phoenix Health team.
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 hospital for surgery or further treatment, and elect to be a private patient, this is where your private hospital cover will kick in. As long as the treatment you receive as an in-patient is included with your Hospital Cover, you will be able to claim up to the Medicare Benefits Schedule (MBS) fee. Learn more about the Medicare Benefits Schedule.
For example, you’re playing football and receive a rough tackle where you land hard on your shoulder. Your partner urgently takes you in their car to your closest private hospital’s emergency facility, where as an out-patient you have scans that indicate you’ve broken your collarbone and require urgent orthopaedic surgery. You’re admitted into hospital and are now considered an in-patient, and will have surgery on your collarbone first thing in the morning.
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 insurance. Out-patient services are generally claimable through Medicare.
For example, you’re playing football and receive a rough tackle where you land hard on your shoulder and are worried about a possible break in your collarbone. Your partner urgently takes you to the closest emergency department where you have an X-ray and an MRI. You see a doctor who advises that you have a non-serious tear in your shoulder and recommends physio treatment over the coming four weeks. The treatment you have received has all been out-patient services.
Did you know…
If you ever need to go to the emergency room of a private hospital, any services you receive will be considered out-patient services and will not be claimable through private health insurance. This includes any facility fee charged, which will become an out-of-pocket cost. Learn more about emergency department fees and charges.
Fees and charges in a public hospital emergency department
If you are eligible for Medicare benefits, you shouldn’t see any bills from your 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 there, or you may 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 you may experience.
Private emergency departments often charge a facility fee which is payable directly to the hospital and 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 services under Phoenix Health hospital cover, if you receive a bill and the ambulance trip is claimable, send it to 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, you’ll often be given discharge medications to continue your treatment at home. There is no benefit payable on discharge medication under your hospital cover, so you won’t be able to claim these costs as part of your hospital admission.
If you hold Extras cover, you may be able to claim a portion of the cost of your discharge medications. We can check this for you – just give us a call.
Post-op doctor 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 may be able to claim a portion of the cost of these appointments through Medicare.
Need assistance before, during or after a hospital admission?
Our Health Support Programs are designed to give eligible members extra support when they need it. From hospital and recovery support to mental health, chronic conditions, pregnancy and early parenting, and joint and mobility support, our programs can help you manage your health and recovery.
Programs are delivered by health professionals, often in conjunction with your treating doctors, and are available to eligible members with Phoenix Health hospital cover.
Explore our Health Support Programs to learn more about the support available and eligibility requirements.
Taking a little extra care of your health right after you’ve had surgery is so important, and while you can’t claim for out-patient 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 can help with 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, wigs after cancer treatment and bras after a 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.
Our Health Support Programs are designed to help you through your hospital experience and recovery. We want you to feel confident and supported, so you can get back to enjoying life sooner. Explore our Health Support Programs to learn more about the support available.
