Step 6 - Understand your procedure and costs
Planning for next steps
As well as talking to your specialist about your health condition and procedures you may need, it is important to discuss the costs of your care prior to treatment.
Hospital stays can encounter out of pocket expenses, excess and co-payments. We recommend you contact us to discuss your level of cover and the information you need from your specialist, to work out any costs before proceeding with any treatments.
Things to discuss with your specialist
In addition to some questions you might have about your condition, treatment and upcoming hospital stay, other things to discuss with your specialist include:
- Can you provide me with all of the relevant Medicare Benefits Schedule (MBS) item numbers for the procedure I am having?
- Will I have to pay a gap between your fee and the amount I’m covered for under my health insurance? Can you provide me with a written estimate of this?
- Will you participate in the Access Gap Cover scheme for my procedure? If so, will your fees be fully covered under Access Gap Cover or will I need to pay a gap?
- Will there be charges from other specialists involved in my treatment? How can I get an estimate of these?
Informed Financial Consent
As well as talking to your specialist to find out about your health condition and any procedures you may be having, it is important to discuss the costs of your care.
Hospital fees and charges
Once your medical specialist has advised you which hospital they wish to admit you to, you should contact the hospital to confirm the costs of your care. Informed financial consent is about understanding any hospital costs before your admission (sometimes in an emergency this may not be possible). This should include information about any potential gaps including radiology and pathology services.
How do I claim if I go to hospital?
When you go to hospital, it can be confusing to work out what can be claimed against your private health insurance, what can be claimed against Medicare, and whether there are any out of pockets. As a starting point, it’s important to understand the difference between hospital and medical costs.