How to avoid paying extra hospital costs
Unexpected medical costs for hospital treatments can be a real headache.This article is going to take a look at the extra hospital costs you may have to pay after your visit, and the best way to anticipate and minimise them so you can get the most from your cover.
What are out-of-pocket costs?
Basically, out-of-pocket costs or ‘gap payments’ refer to any cost for hospital services or treatment that your insurer or Medicare won’t reimburse you for. For private patients in hospital, the government pays 75 per cent of a set amount called the Medicare Benefits Schedule fee and your insurer tips in the remaining 25 per cent.
The catch is, doctors aren’t bound to the Medicare Benefits Schedule fee and often will charge more. Any charge above this amount is known as the ‘medical gap’.
‘No gap’ and ‘known gap’ agreements
In many cases, doctors will have agreements with health funds to help cover this gap. If your doctor recovers all of the medical gap from your health fund this is called a ‘no gap’ agreement and you won’t have to front up the rest of the costs. However, if the doctor only recovers some of the medical gap agreement this is a ‘known gap’ agreement and you will be required to pay the additional charges.
Gaps can also occur for:
- Additional doctors involved in your produce (like an anaesthetist or radiologist).
- Non-medical services at the hospital, such as accommodation.
- Various tests such as x-rays or pathology.
- Extras such as TV rental or newspapers.
How to I avoid these extra charges?
The best way to avoid these extra charges is to talk to your surgeon and health fund. If the extra charges make surgery more expensive telling these parties can help provide options. That being said, when you’re sick you may not be in a good position to discuss these changes with a doctor so it’s recommended you consult with a family member, friend or loved one to help avoid this.
What questions should I ask?
Consumer resource CHOICE has provided a guide to the sort of questions you should ask. When you find out that you need medical treatment, you should call your health fund and ask:
- Does my policy cover treatment I require and have I served any waiting times?
- Do I have to pay an excess or co-payment?
Ask your specialist about:
- Extra costs for your surgery or treatment.
- Contact details of anyone else involved.
- Extra costs for a prosthetic such as an artificial hip or a pacemaker.
You should also get a letter from your specialist with all these details before the surgery.
Go back to your health fund to:
- Confirm any extra costs and the benefit from your fund.
- Ask if the fund has an agreement with the hospital you are going to.
- If the fund can't tell you about extra costs, contact the hospital.
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