Member Insider - your rights as a private patient

Welcome to CBHS Health's first Member Insider! This will be a recurring series covering the ins and outs of private health insurance to ensure our members are informed of their options and opportunities when it comes to their coverage.

Should I use my private health insurance when I am admitted to a public hospital?

You have the right to choose when to use your health insurance. If you can’t see any advantage in using your health insurance in a public hospital, you are well within your rights not to and you can be admitted as a public patient. Public hospitals must treat you as a public patient if you choose that option, regardless of your health insurance status. Under Medicare, any Australian resident admitted as a public patient in a public hospital is entitled to treatment by a doctor appointed by the hospital, at a time determined by the hospital. Medicare pays for your accommodation, meals, medical and nursing care, theatre and other fees related to your treatment. This means that anyone that chooses to be admitted into a public hospital as a public patient (that is, without using their health insurance) receives full coverage from Medicare directly.

Will I get better treatment if I use my private health insurance when I am admitted to a public hospital?

If you choose to use your private health insurance when admitted to a public hospital, in most cases this may not guarantee any improved or special medical treatment.

In public hospitals, private rooms are generally allocated to people who medically need them the most. Whilst you can request a private room as a private patient, you may not always be allocated one depending on availability. The hospital may also transfer you from a private room to a shared room during your stay if another patient has a greater need for the private room.

You also have the option to choose your doctor, should you be admitted privately in a public hospital, however depending on your illness or condition and the size of the hospital, this may be the same doctor who would have been allocated to you by the hospital as a public patient.

Should you elect to use your health insurance in a public hospital, there may be costs for you to pay that would not be payable under Medicare. These costs include excess payments, and additional out-of-pocket costs that your doctor may charge for your treatment. Some public hospitals might agree to pay for out-of-pocket costs you will incur for using your insurance. Before deciding whether to use your health insurance, you should confirm with the hospital if you will have to pay any out-of-pocket costs (or ‘gap’).

When should I use my health insurance in a public hospital?

You should ask the hospital a few questions when being admitted. The answers should then allow you to make a more informed decision as to whether to use your insurance or not:

• How will I benefit from electing to use my CBHS Health membership in this public hospital?
• Will I be treated differently as a private patient compared to a public patient?
• Can you guarantee me a private room for the length of my stay?
• Can I choose my own doctor?

How will I know how much my out-of-pocket costs will be?

Knowing how much your treatment is going to cost is called Informed Financial Consent (IFC). You have the right to be provided with IFC from both your doctors and the hospital.

What to ask your treating doctor or specialist

Before you are treated, ask how much their fee will be, and if you will need to pay a gap. For major treatment, this information should preferably be provided in writing.

You may have more than one doctor involved in your treatment, for example, a surgeon and anaesthetist. Your surgeon should be able to advise who else will be treating you and how you can contact the other doctors to seek fee information from them.

You may have lower or no out-of-pocket medical costs if your treating doctors elect to participate in CBHS Health’s Access Gap Cover scheme. You are entitled to ask your doctors if they will participate in our scheme. It is completely up to your doctor whether to participate in our scheme. CBHS Health has no input into this decision.

What to ask CBHS Health

Ask us whether your policy will cover the procedure, and whether you will need to pay an excess, co-payment or any other charge associated with the treatment. You may need to obtain the Medicare item numbers from your doctor so that we can give you an accurate quote.

What to ask the hospital

Ask whether they have an agreement with CBHS Health and whether you will have to pay any gap or out-of-pocket costs. Your hospital should perform a membership eligibility check with CBHS Health before you are admitted and obtain your IFC to incur any out-of-pocket costs associated with your admission. This information should preferably be provided in writing.

What if it is an emergency?

There will be circumstances where it may not be possible for the hospital to obtain IFC before the treatment is provided. In that case, fee information should be provided to your relative or representative before treatment is provided. If this is not possible, IFC should be obtained from you as soon as possible.

So, it’s my decision?

Yes. Before you decide, make sure you talk to the hospital and your treating doctors so that you can make an informed decision. You can also contact us if you need further assistance.

If you have any questions or topics you’d like explored as part of Member Insider, please email us at help@cbhs.com.au with Member Insider as your subject line.