Going to hospital can be daunting whether it be your first time or one of many. This information will take you through the steps of planning your upcoming admission and some important questions to ask.
Before going to hospital
1. Speak to Navy Health
Get prepared for your hospital visit by ensuring you’re fully aware of your condition, what your treatment will include and the cost of your treatment.
Contact Member Services at Navy Health on 1300 306 289 to discuss the following:
- What is my level of cover?
- What does my cover include?
- Have all my waiting periods been served?
- Are my premiums up to date?
2. Talk to your GP and Specialist
Your GP or Specialist is generally your first step before you receive hospital admission. They will analyse your condition, level of treatment and whether you will need help from other specialists. It is important to ask questions and discuss any tests or procedures you may need.
Some questions to consider are:
• What do I need to know about my condition, i.e. symptoms, tests and treatment?
• How long will I be in hospital?
• What are the expected costs? Will there be out-of-pocket costs?
• Does the specialist participate in the Access Gap scheme?
• Do I have the option to see a specialist of my choice?*
• What should I do to prepare for my admission?
• Will I need to take medication and if so, for how long?
• Are there any risks involved with my treatment?
• What is the duration of my admission?
• Are other specialists involved in the procedure?
Your doctor may recommend dates for your treatment or book your hospital admission during your appointment.
When organizing your pre-admission appointment, ensure you receive all the correct details and ask for an admission pack from the hospital outlining all the details.
*Refer to the Find a Specialist page for a free, comprehensive, up-to-date search directory of Australian private practising specialists and allied practitioners.
3. Admission to hospital
As an Australian resident holding a Medicare card, you are entitled to treatment as a public patient by a doctor employed by the hospital at a time set by the hospital, at no cost. All hospital inclusions such as accommodation, meals, medical and nursing care related to the treatment are also covered under Medicare. Because this is funded by Medicare, you do not need to have private health insurance to be treated as a public patient in a public hospital.
As a public patient in a public hospital, you’re more likely to incur longer waiting lists for elective surgeries. If you don’t mind waiting for your surgery, you may choose not to claim your treatment on your private health insurance and just enlist yourself as a public patient. In a private hospital, you’re likely to receive treatment sooner. You are also able to nominate your chosen doctor and choose from over 500 private hospitals. Navy Health’s contracted hospitals have an agreed level of fees that is charged by the hospital to Navy Health, to be paid on your behalf. If you choose a hospital outside of the 500 affiliated hospitals, you may be subject to out-of-pocket expenses.
4. Expenses
Private hospital cover is designed to pay for hospital charges and to contribute to your doctor’s fees. Costs may be incurred if you have waiting periods, an excess or 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.
There are generally two different ways your treating doctors may bill for their services. As a private patient, you are entitled to ask your treating doctors to give you Informed Financial Consent. This document will be given to you on request from your doctor and will tell you how much you will be “out-of-pocket” at the end of your planned hospitalization.
Access Gap
When treated as a private patient in hospital, members may face out of pocket expenses if the treating doctor charges more than the Medicare Benefits Schedule (MBS). The Access Gap scheme is designed to help minimise or eliminate these costs. Where an agreement is in place, and the treating doctor chooses to participate in the Access Gap Scheme, Navy Health is able to pay a further benefit towards medical expenses above the MBS. We encourage you to ask your treating doctors to use the Access Gap scheme to help alleviate any out of pocket expenses for your treatment in hospital.
Gap Medical
If your treating doctor does not participate in the Access Gap scheme, Gap Medical benefits will apply. Under Gap Medical benefits, Medicare will cover 75% of the MBS and Navy Health will pay the remaining 25% of the MBS. If the doctor charges more than the MBS fee, the member will be responsible for any ‘gap’ payment. The ‘gap’ is the difference between the MBS fee and the doctor’s fee.
