Going to hospital

Going to hospital, whether planned or in an emergency, can be a confusing time - particularly if it’s your first hospital visit. We want to make it as easy as possible for you to understand how going to hospital works – so you can focus on your health and recovery.

Before you go into hospital

Talk to your doctor

It’s important that you take the time to learn about your condition and all the available treatment options so you can be confident in your decisions. Your doctor or specialist should be able to provide you with enough information for you to feel comfortable that all your questions have been answered.

You should also talk to your doctor about the costs involved in your procedure. Your doctor is required to provide you with an estimate of the potential expenses associated with your treatment.

Check your level of cover

You need to know exactly what your level of cover includes before you make any decisions about your hospital and procedures. Phone us on 1800 335 425 to be sure.

Choose your hospital

As a Defence Health member, you’re entitled to go to a private hospital of your choice, or a day hospital facility, and to be treated by your preferred doctor or specialist.

Defence Health has agreements with over 500 private hospitals – these are called “agreement hospitals”. This ensures that an agreed schedule of fees (including in-patient accommodation, theatre and special unit accommodation fees as appropriate) is charged by the hospital and paid by Defence Health on your behalf.  

If you choose a non-agreement hospital, you may incur out-of-pocket expenses for hospital related services – irrespective of your level of cover.

If you choose to be a private patient in a public hospital, you will have out-of-pocket expenses if the hospital charges are greater than the Defence Health benefit. 

Hospital costs

What costs will I incur?

Private hospital cover is designed to pay for hospital charges and to contribute to your doctors’ charges.  Costs may be incurred if you have waiting periods, an excess, or other exclusions on your own cover. You can and should check your cover with us before you go to hospital.

Out of pocket costs may be incurred for:

  • payments to your treatment practitioners who charge fees higher than those prescribed by the Government’s Medical Benefits Schedule. You may be able to reduce these costs if your doctor agrees to use Access Gap Cover
  • high cost drugs and for take home items such as crutches and pharmaceuticals.
  • costs associated with a long stay, prosthesis, specialist fees or diagnostic services
  • personal expenses such as phone calls, newspapers, TV hire, massage and hairdressing, or use of an executive or similar suite.

In-patient versus out-patient costs

When you’re admitted to hospital – either overnight or just for day surgery – you become an in-patient. It’s only when you’re an in-patient that your private health insurance can cover the hospital charges (and contribute to your medical fees).

If you have a consultation in your doctor’s rooms within the hospital, or visit the hospital for a diagnostic test, you are an out-patient. Any charges related to out-patient treatment cannot be covered by Defence Health and should be forwarded to Medicare.

There’s more information on in-patient and out-patient care in this Health HQ article.

Claiming your costs

When you’re discharged from hospital, Defence Health will generally settle your account directly with the hospital.

If your doctor agrees to use Access Gap the medical bill will be sent to us for payment. Otherwise, you will need to send the doctor or specialist account to Medicare. Then, when you receive the Medicare statement of benefit, just send it to us for our contribution.

If there is an amount payable by you, your doctor should have advised you of this prior to your treatment.

Tip: if you tick the box on the Medicare claim form you’ll receive the statement of benefit in the post. If not, you’ll need to login to your myGov.au account and download the relevant statement from your inbox.

For more information, check out the Going to Hospital brochure