Step 1 - Understand Your Cover
Before you go in to hospital, the first thing you need to do is make sure you understand what you are covered for with CBHS. Below is a checklist that you should follow.
What is your level of cover?
You can find out your level of cover from our Online Member Service Centre, or by calling us on 1300 654 123.
Do you have any waiting periods?
Waiting periods apply to all CBHS covers for new members or members upgrading their cover. To check if any waiting periods apply to your cover, you can call 1300 654 123. If you have had your current level of cover for over 12 months, it is most likely that waiting periods will not apply. For more information on waiting periods click here.
Do you have an Excess on your cover?
On Comprehensive and Limited Hospital covers, you have the option of taking a Daily Excess option to reduce your contribution rates. Check if you have an Excess on your cover by looking at your last CBHS cover statement, or logging on to the Online Member Service Centre. For more information on Daily Excess Options click here.
Are you going to be staying overnight?
Ask your doctor whether you will be required to stay overnight for the treatment, or whether it will be a day surgery treatment.
What type of service will you be receiving?
Some specialty services have particular restrictions on them. Ask your doctor about the type of service you will be receiving, for example rehabilitation or new hip.
Does your cover have restricted services?
Check if your level of cover has any restrictions by visiting the Online Member Service Centre or calling CBHS. For more information about restricted services click here.
Step 2 - Obtaining a Quote
By obtaining a quote from your specialist and other medical service providers involved in your hospitalisation (e.g. anaesthetist, assisting surgeon, pathologist and/or radiologist) you are eliminating any unexpected bills arriving after your hospital stay.
If your specialist agrees to charge you under the Access Gap Scheme you may not even see the bill, as it may be sent directly to CBHS for payment.
Access Gap Cover
Access Gap Cover allows CBHS to pay above the schedule fee for doctors' services provided to you as an inpatient, covering the entire doctors' fee or leaving you with significantly reduced out-of-pocket expenses.
Doctors can choose to participate in Access Gap Cover on a patient-by-patient basis, so you should discuss Access Gap Cover with your doctor. If your doctor charges the Access Gap fee, you will have nothing to pay. Even if they charge above the Access Gap fee you will be able to establish the 'gap' you may have to pay before receiving treatment.
For more information on Access Gap, including a list of doctors who have previously participated and a checklist of questions to ask your provider, click here.
Step 3 - Check your Hospital has an Agreement
CBHS has agreements with most Australian private hospitals and day hospitals. Subject to your level of cover, these agreements provide for in-patient accommodation fees including bed fees, theatre and labour ward, intensive and coronary care fees. To check if your hospital has an agreement please log on to the Online Member Service Centre and select Provider Search/Hospital Search from the left hand menu bar.
If your chosen hospital does not have an agreement in place with CBHS, you will be covered up to pre-set limits (set by the Government) and will incur significant out-of-pocket expenses.
Step 4 - What are the Benefits Payable by CBHS
Below are a number of questions to help you determine what you can expect CBHS to pay for.
1) Do you have an excess on your cover?
* Yes - go to question 2
* No - go to question 3
2) Have you already been admitted into hospital for 6 or more days this calendar year and paid your Daily Excess?
* Yes - the maximum Daily Excess payable is 6 days per person per calendar year - you are not required to pay any further Excess this calendar year (continue to question 3)
* No - you will need to pay the relevant Daily Excess each day that you are hospitalised up to a maximum of 6 days (continue to question 3)
3) Is the service limited on my membership?
* Yes - go to question 4
* No - go to question 5
4) Are you receiving the limited service in a public hospital in a shared room?
* Yes - CBHS will pay benefits towards your accommodation (continue to question 6)
* No - If you are going into a private room in a public hospital, or going into a private hospital you will have significant out-of-pocket expenses. Contact CBHS to find out the benefits you will receive (continue to question 6)
5) Does your hospital have an agreement with CBHS?
* Yes - You will be covered for accommodation, theatre, labour ward, intensive and coronary care fees. (continue to question 6)
* No - you will have significant out-of-pocket expenses. Please contact CBHS for more information (continue to question 6)
6) Is your doctor, and other specialists involved in your treatment charging, you under Access Gap Cover?
* Yes - Your doctor will have provided you with a written estimate of fees and you should be aware of any out-of-pocket expenses
* No - You will be covered for 100% of the schedule fee set by the Department of Health and Aging (Medicare pay 75% of schedule fee and CBHS pay 25%). If your doctor and other specialists charge above this fee you will have to pay the difference. Ask your doctor and specialists what your expected out-of-pocket expenses are.
Answering these questions should give you a clear idea of the benefits you will receive from CBHS and any expenses that you will have to pay. If you are still not sure please contact the CBHS Member Care Centre on 1300 654 123 for more information.
Step 5 - Claiming Your Benefits
Hospital Bills
Hospitals will bill CBHS directly. If you are required to contribute to your admission (for example you have selected to pay an excess, or have restricted cover) you will be required to pay this directly to the hospital. Please check with the hospital whether you have to pay this upon admission or if they will bill you.
Doctor and Specialist Bills
If your doctor or specialist participated in the Access Gap Cover scheme
Your doctor should bill CBHS directly. If the doctor sent the bill to you, please forward this to CBHS. Do not take it to Medicare first as we will forward it to Medicare on your behalf once we have processed our portion.
If your specialist did not participate in the Access Gap Cover scheme
Please take the bills to Medicare. Medicare must process the claim before CBHS can provide any benefits.