Going to Hospital

When you’re admitted to hospital for an operation, there are a number of fees involved. If your procedure is covered under your see-u policy, a lot of it will be taken care of for you.

The benefit we pay towards in-hospital medical services is based on your level of cover for the services under your policy, and whether you are admitted to an Agreement hospital or non-agreement one.

You may incur out-of-pocket expenses for:

• Services which are not medically necessary or treatments that are not eligible for Medicare benefits
• Charges above the Medicare Benefits Schedule
• Admission into a non-agreement hospital
• Treatment for a restricted service
• Personal items (e.g. Newspapers, toiletries, TV etc.)
• Medical Devices and Human Tissue Products that are not on the Federal Government’s Prescribed List or that are not surgically implanted
• Some pharmaceuticals E.g. high cost drugs, trial medications etc.
• Treatment received from a service provider e.g. Physiotherapist who aren’t directly employed by the hospital you’re treated in. (Benefits may be payable towards these services if you have an Extras cover).

If you have a medical problem (unless in an emergency situation), your GP may refer you to a specialist. Your specialist will assess your condition and recommend treatment, which may require surgery and/or being admitted to hospital. If you are required to go to hospital, your specialist will work with you to decide the date and which hospital you’ll be treated at.

This initial appointment is not covered by Hospital cover, however Medicare may cover part of this bill.

see-u Hospital Cover doesn’t cover any treatment in an Emergency Department. If you need to visit an Emergency Department, you can be treated at a public hospital under Medicare or pay for the fees yourself in a private hospital’s Emergency Department.

If you’re admitted to a private hospital after treatment in an Emergency Department, the fees associated with your admission and further treatment will be covered, so long as the treatment is listed on your policy.

Your hospital excess is capped at once per person per calendar year. If you're re-admitted to hospital in the same year (for the same or a different condition), you won't have to pay another excess.

For peace of mind, all see-u Hospital Cover options have a capped excess, so if your stay is extended, you won’t have to worry about accruing a huge medical bill. If you’re having additional procedures during the same admission, these same excess caps apply. Please refer to your Product Summary for information regarding your excess payments.

If need to stay longer or need more procedures, the hospital will call us to ensure you’re covered. Remember to still ask your doctor to treat you under the Access Gap Cover Scheme and if there will be any out of pocket expenses for you.

When you arrive at the hospital, you’ll be asked to sign yourself in at the admissions desk. The hospital will ask for your private health insurance information and they’ll call us to confirm your cover. You’ll then be asked to pay your excess directly to the hospital.

Before you have any treatment, you have the right to know what expenses you may have to pay (what’s known as Informed Financial Consent).

Things to ask your specialist include:

• Can you and any other doctors involved treat me under the Access Gap Cover Scheme?
• Will there be any out-of-pocket expenses and if so, how much? (Ask for a written quote.)
• Can you provide me with the relevant Medicare Benefits Scheme (MBS) item numbers?
• If you’re getting prosthesis (i.e. hip and knee joint replacements, artificial heart valves, pacemaker devices and intra-ocular lenses for cataract surgery): What expenses are involved?

Call see-u on 1300 499 260 and ask:

• Is my treatment covered under my policy?
• How much of my procedure and hospital visit is covered?
• How much will my excess be?
• Have I served my waiting period?
• Are my premiums paid up to date?

When it comes to medical treatment, it can feel like everyone is speaking a different language. Here’s your quick guide to what it all means.

Specialist: A doctor who has further training in a specific field of medicine. They may be a surgeon (who performs operations) or a physician (who treats conditions with the use of medicine). Examples of specialists include Cardiologists who look after the heart, Oncologists who treat cancer and Orthopaedic surgeons who operate on bones.

Anaesthetist: A doctor who is responsible for administering anaesthetist to patients for medical treatment. They provide general anaesthetist (which makes the patient unconscious) or local anaesthetist (which numbs a specific area while the patient is awake).

Admitted: Being admitted to hospital means you are being treated as an ‘inpatient’ as opposed to an ‘outpatient’ or in the emergency room. In most circumstances, people admitted to hospital will stay at least overnight.

The gap: The Medicare Benefits Schedule (MBS) is a list of medical procedures and a suggested amount doctors should charge for each, as recommended by the Federal Government (think of it like a recommended retail price). When you have an operation, Medicare will pay 75% of the MBS fee and health insurers pay the other 25%. Because the MBS is only a recommended fee though, many doctors charge above it – leaving a ‘gap’ between what is paid for you and the fee you’ve been charged.

Access Gap Cover Scheme: see-u may pay for some of the gap or even the entire gap for you if your doctor will treat you under the Access Gap Cover Scheme. It’s important to ask your specialist before making arrangements with the hospital if they will treat you under the Scheme as it’s voluntary for them to do so. If they choose not to treat you under the Scheme, you’re able to ask for a specialist who will.

The Access Gap Cover Scheme also makes claiming a breeze – having see-u and your hospital work together to take care of everything for you. If you’re treated under the Scheme, you’ll sign a claim form on admission and you may never even see a doctor’s bill.