Private Health Insurance Statements (Tax Statement) for members will be available in your Astute Simplicity Health member account and your MyGov account from mid-July. Learn more.

Going to a Private Hospital

Going to a Private Hospital

Going to hospital can be a stressful experience, especially when you are uncertain of what the out-of-pocket costs may be. At Astute Simplicity Health, we want to make this sometimes difficult situation a little easier.

Ask your Doctor:

  • What is the expected cost of treatment? Ask your doctor for a written quote that includes the Medicare Benefit Schedule item numbers to be used for your treatment.
  • Will other doctors be involved in your treatment, such as anaesthetist and assistant surgeons? Ask how you can find out what their charges will be.
  • Is your doctor willing to participate in St.LukesHealth Medical Gap? If so, your out-of-pocket costs can be reduced. For more information visit the St.LukesHealth Medical Gap page.
  • Do you require any surgically implanted prosthesis? If yes, ask if the prosthesis attracts a patient gap or if there is an option to use a no-gap prosthesis.

Ask your Admissions Clerk:

  • Will you be staying in a private room?
  • Will there be additional costs for items like newspapers and television?
  • Are there other out-of-pocket costs you should be aware of associated with your hospitalisation?
  • Will there be an additional cost for guests who may stay at the hospital with you but are not receiving treatment?

Ask Astute Simplicity Health:

  • If your treatment is covered under your current private health insurance policy.
  • If all waiting periods have been served for the treatment you require.
  • Ask if you have an overnight or same-day hospital excess? If so, how much applies?
  • Are you being treated in a private hospital contracted with the underwriter St.LukesHealth? If not, what impact will this have on my hospital bill?
  • What are the expected out-of-pocket costs?

Who pays?

If you hold private hospital cover, your private health insurer will provide cover towards the cost of the hospital portion of your admission. This includes theatre and accommodation fees for treatment received in a contracted private hospital within Australia. Any fees associated with intensive or coronary care, as well as the cost of approved surgically implanted prostheses involved in your treatment will be subject to your level of cover and any waiting periods that may apply.

When you receive a medical service in hospital, Medicare will pay a benefit of 75 per cent of the Medicare Benefits Schedule fee and your private hospital cover will pay the remaining 25 per cent of the Medicare Benefits Schedule fee. However, doctors can charge above the schedule fee and when they do, the difference between the Medicare Benefits Schedule fee and your doctor’s fee is called the ‘gap’. If the doctor has charged you more than the scheduled fee, you are responsible for paying the difference or the ‘gap’ unless they charge you under the St.LukesHealth Medical Gap scheme.

If you would like clarification on your cover, please contact us directly on 1300 090 960.


Want to find out more?

Call today on 1300 090 960

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