Going to Hospital

Heading to hospital for an operation? Here's the lowdown on what to expect. If your procedure is covered by your see-u policy, we’ll cover a lot of the costs, but there are still a few things you might need to pay for yourself.

The amount we chip in depends on:

• Your level of cover.
• Whether you’re admitted to an agreement hospital (we’ve got a deal with them) or a non-agreement hospital (we don’t).

You could have some out-of-pocket costs for things like:

• Treatments not covered by Medicare or that aren’t considered medically necessary.
• Charges that go above the Medicare Benefits Schedule (MBS).
• Staying in a non-agreement hospital.
• Treatments for services listed as restricted under your policy.
• Personal items, like newspapers, toiletries, or using the hospital TV.
• Medical devices or human tissue products that aren’t on the Government’s approved list (or aren’t surgically implanted).
• Some meds, like high-cost drugs or trial medications.
• Services from providers like physios who aren’t directly employed by the hospital. (Extras cover might help with these, so check your policy!)

If you’re unsure about what’s covered or need help figuring it all out, reach out to the see-u crew. We’ve got your back!

If you’ve got a medical issue (and it’s not an emergency), your GP might refer you to a specialist. Here’s what usually happens next:

Your specialist will check out what’s going on and recommend a treatment plan.
If treatment involves surgery or a hospital stay, they’ll help you lock in a date and choose which hospital to go to.
Heads up: that first appointment with your specialist isn’t covered by your Hospital cover. But don’t stress—Medicare might chip in to cover part of the cost.

Got more questions? The see-u crew is here to help you navigate it all!

Good news—your hospital excess is capped at once per person each calendar year. So, if you’re admitted to hospital again later in the same year (whether it’s for the same issue or something different), you won’t need to pay the excess again.

If you’re still unsure how it works, give the see-u crew a shout.

Take a deep breath—we’ve got you. All see-u Hospital Cover options come with a capped excess, so even if your hospital stay gets extended or you need extra procedures during the same admission, you won’t be hit with surprise excess charges.

Here’s how it works:

• If your stay is extended or additional procedures are needed, the hospital will contact us to confirm your cover.
• The same excess cap applies—no matter how long you’re there.
• To keep costs low, ask your doctor to treat you under the Access Gap Cover Scheme and check if there are any out-of-pocket expenses to budget for.

For more details on your excess payments, check your Product Summary or reach out to the see-u crew for a chat!

When you rock up at the hospital, here’s what to expect:

1. Head to the admissions desk and sign yourself in.
2. The hospital will ask for your private health insurance details and give us a call to confirm your cover.
3. You’ll be asked to pay your excess directly to the hospital before you’re admitted.

It’s pretty straightforward, but if you’ve got questions or need a hand before you go, the see-u crew is just a call away!

Before heading to hospital, it’s important to know exactly what you might need to pay (this is called Informed Financial Consent). Here’s a checklist to help you feel prepped and ready:

Ask your specialist:

• Can you and any other doctors involved treat me under the Access Gap Cover Scheme?
• Will there be any out-of-pocket expenses, and how much? (Get it in writing!)
• Can you provide the relevant Medicare Benefits Scheme (MBS) item numbers?
• If I’m getting a prosthesis (like a hip or knee replacement, pacemaker, or intra-ocular lens for cataract surgery), what costs should I expect?

Call see-u on 1300 499 260 to check:

• Is my treatment covered under my policy?
• How much of my procedure and hospital stay will be covered?
• What’s my excess amount?
• Have I served my waiting period?
• Are my premiums all up to date?

A little planning now can save a lot of stress later!

When it comes to medical treatment, it can sometimes feel like everyone’s speaking a different language. Don’t worry—we’ve broken it down for you:

Specialist

A specialist is a doctor who has extra training in a particular area of medicine. They could be a surgeon (who performs operations) or a physician (who treats conditions with medication). Examples include:

• Cardiologists (heart specialists)
• Oncologists (cancer specialists)
• Orthopaedic surgeons (bone specialists)

Anaesthetist

This doctor is in charge of making sure you’re comfortable during your treatment by giving you anaesthesia. There are two main types:

• General anaesthesia (puts you to sleep)
• Local anaesthesia (numbs a specific area while you stay awake)

Admitted

When you're admitted to hospital, it means you're being treated as an inpatient (as opposed to an outpatient or being seen in the emergency room). This usually means you'll stay at least one night.

The Gap

The Medicare Benefits Schedule (MBS) is a list of recommended fees for medical procedures. Medicare covers 75% of these fees, while health insurers (like us) cover the other 25%. However, some doctors charge more than the MBS rate, leaving you with a “gap” to pay.

Access Gap Cover Scheme

Here’s where it gets handy: if your doctor agrees to treat you under the Access Gap Cover Scheme, see-u may cover some or all of the gap. It's important to check with your specialist if they’re on board with the scheme, as it’s entirely voluntary for them. If they’re not, you can ask for a specialist who is.

The best part? If you're treated under the Scheme, see-u and your hospital team up to handle the paperwork, meaning you might not even see a doctor’s bill. Easy, right?