Using private health cover in public hospitals
In many cases, a visit to emergency won’t result in an admission into hospital1. But if you need to be admitted for further monitoring and treatment, what are your options as a patient when in a public hospital?
Up to this point, any costs associated with your visit – such as doctors’ fees and tests – will be covered by Medicare if you are eligible. This means it is unlikely that you will have any out-of-pocket costs for the services that were provided to you while in the emergency department and you don’t need to engage with your private health insurance (this is different to what happens in a private hospital emergency department. Read more about the difference between private and public emergency departments here).
However, it is from the time at which you are admitted that this can change. You may be given the choice to be admitted into the public hospital as a public or private patient. Before signing the patient election form, it’s important to know all the facts so you can make a decision that best suits you.
What does it mean to be a private patient in a public hospital?
To be privately covered in a public hospital means your private health insurance policy with Doctors’ Health Fund will cover your admission. This is different to being a public patient, whereby any medically necessary costs are fully covered by Medicare.
Costs associated with an admission can include accommodation, medical fees and theatre fees if you have surgery.
Just because you have private health insurance, you don't have to use it
It’s your choice as to whether you are covered as a public or private patient. You have a right to be a public patient, even if you have private health insurance, and this should not affect the level of clinical care you receive.
If you choose to be covered as a public patient, all medically necessary inpatient costs will be covered by Medicare if you are eligible.
Understand the benefits of using your health cover
If you choose to use your private health insurance, benefits such as choice of doctor, access to a single room and specialised follow up care should take priority and be asked of the public hospital as part of your admission. However, while these are key benefits of being a private patient, it’s important to remember that they do depend on availability. Single rooms aren’t guaranteed and are usually allocated based on medical need rather than health cover, and your preferred doctor may be unavailable or not work at the public hospital. It could be more beneficial and less costly to be a public patient if this is the case.
Be prepared for possible out-of-pocket costs and know what your policy covers before deciding to be a private patient
Your Doctors’ Health Fund policy will apply to your admission if you choose to be a private patient in a public hospital. This means, you may be required to pay any excess (although many public hospitals waive the excess) and the doctor who treats you, including an anaesthetist if you require surgery, may charge a gap for their services above what Medicare and the health fund will cover. So you can understand and have full transparency of these costs, the public hospital is required to provide you with Informed Financial Consent if you choose to be a private patient. They will also contact us to confirm your cover.
It is important to remember that if you are covered by our Smart Starter Bronze Plus, any exclusions or restrictions of your policy will apply, so you may not be covered for the services you require.
Key takeaways:
- It’s your choice whether you are admitted into hospital as a private or public patient.
- There is no obligation to use your private health insurance.
- Benefits such choice of doctor and access to a single room should be asked of the public hospital if you choose to be a private patient, but aren’t guaranteed.
- Be prepared for possible out-of-pocket costs if you choose to be a private patient and ensure the hospital provides Informed Financial Consent as they are required to do so.
1Health Direct. Hospital Emergency Departments, source: https://www.healthdirect.gov.au/hospital-emergency-departments
IMPORTANT: Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy, available at www.doctorshealthfund.com.au/our-cover.
Please note this article provides general advice and does not consider all situations.
