Hospital fees and charges

Hospital fees and charges 

If you have chosen to have an excess on your hospital cover, you will need to pay this to the hospital, usually before your admission. You should also confirm whether there are any additional costs associated with:

  • Accessing a private room
  • Potential out of pocket expenses for services like radiology or pathology
  • Additional costs for robotic services
  • Medications
  • Other services offered during your stay

Excess & co-payments

Excess and co-payments relate to an amount of money you as the policy holder agrees to pay before private health insurance benefits are payable. A co-payment generally applies every time you or someone on your policy goes to hospital in a year; an excess is generally capped at a total amount for the year. We encourage you to contact GMHBA so that you are clear on what excess and co-payment costs you may have to pay.

Extra costs

Some hospitals charge for additional services like WiFi, TV, newspapers, phone calls or partner meals. Generally all details of additional costs are provided in your room or prior to admission but if you require any of these services you can enquire ahead of time.

All dressings, single-use equipment, single-use medical devices and disposables (including laparoscopic and robotic disposables unless approved by GMHBA prior to surgery) are included in the procedure and/or accommodation rates and will not be paid for separately by the fund.

Access Gap Cover

Specialists can opt in or out of the Access Gap Cover scheme on a patient by patient and procedure by procedure basis – just because they do participate in the scheme doesn’t mean that they always use it. Ask your specialist if they will be using Access Gap Cover for your treatment. 

Care in a private hospital

GMHBA has agreements with a large number of private hospitals in Australia. We recommend you check our participating hospital list to confirm that GMHBA has an agreement in place with the hospital where your medical specialist wishes to admit you.

For an admission to a contracted hospital, GMHBA can pay benefits that cover:

  • Hospital accommodation and meals
  • Nursing
  • Intensive care and operating theatre fees
  • Government listed surgically implanted prostheses, eg for a hip or knee replacement

If the hospital does not have a contract with GMHBA, benefits can still be paid up to a default rate, however you are likely to have a significant gap to pay.

In Australia, medical services provided by doctors have a Medicare Benefits Schedule (MBS) fee, set by the Government. This is called the scheduled fee. Medicare pays 100% of the scheduled fee for GPs and 85% of the scheduled fee for specialists. If the doctor chooses to bill above the scheduled fee, you will have to pay the difference.

Private health insurers are not permitted to pay any benefits for medical services provided out of hospital (i.e. any services other than those provided while you are an admitted hospital inpatient).

When a specialist is treating you in a hospital, they are able to opt in or out of the Access Gap Cover scheme on a patient by patient and procedure by procedure basis – just because they do participate in the scheme doesn’t mean that they always use it.

Follow up and ongoing treatment

After going to hospital, your specialist will provide information on expected recovery and rehabilitation needs.

It is important that you carefully follow this information, to ensure the best recovery for yourself.

Many surgeries require rehabilitation, for example physiotherapy. You can check your extras cover to ensure you’re covered for benefits towards these services.

If you are unclear or need any further information relating to your health insurance please contact us.