Health Check

Understanding hospital costs

Don’t be caught out by unexpected costs.

Written by Editor Medibank
Professional doctor writing medical records on a clipboard with computer and medical equipment all around, desktop top view

At Medibank, we know that going to hospital can be a challenging time. So we hope this collection of information and advice on your hospital stay helps you have a safe and comfortable stay, and a strong recovery.

Being in hospital doesn’t just put a lot of extra stress on your body and mind, it can also be costly. If you're heading to hospital, it’s important that you are comfortable with the costs you can expect—and get a second opinion if you’re not.

Here are five tips for preparing financially for hospital:

1. Don’t be caught by surprise fees

Ask about costs early on to avoid surprise out-of-pocket expenses.

If you are having surgery, be aware that there is wide variability between the fees different surgeons, anaesthetists and other medical providers charge in Australia. And paying more doesn’t necessarily mean you’ll get better quality care. Here are the top questions to ask before surgery.

2. Ask for a break-down of charges

Before going to hospital, ask about the fees that each health professional in the team and the hospital will charge, and any out-of-pocket expenses you might incur. This information should be provided in writing before your treatment or hospital admission and is known as informed financial consent.

For example the anaesthetist, surgeon and surgical assistant will bill separately.

3. Clarify what you will need to pay out-of-pocket

Get an estimate of the total cost and any out-of-pocket expenses you’ll need to pay.

If your doctor chooses to charge more than the Medicare Benefits Schedule fee (the amount subsidised by the Australian Government through Medicare), you will need to pay an out-of-pocket expense. This is also commonly referred to as the ‘gap’. Talk to your doctor if anything seems confusing.

There may also be additional expenses for medical services, such as blood tests, x-rays just to name a few. You should ask the hospital and your doctor what these might be.

4. Find out how much your insurance will cover for your hospital treatment

If you have private health insurance, find out how much your policy will cover. You should also check whether you have to pay an excess and/or co-payment .

Keep in mind that for in-hospital medical services, Medicare will pay 75% of the standard Medicare Benefits Schedule fee for your procedure, while your health insurer pays the other 25%. If you are with Medibank, ask if your doctor participates in 'GapCover.' If they do, Medibank will pay some or all of the gap for you to reduce your out-of-pocket costs.

If you have any questions, give your private health insurer a call.

5. Where possible, take time to consider the costs

Take some time to consider the information you’ve been given, including fees. If the figure your doctor quotes sounds higher than you expected, don’t be afraid to ask around.

Depending on the nature of your procedure, your doctor should allow you enough time to assess the financial impact without pressuring you to decide right away.

If you have any other questions about costs, be sure to talk to the hospital, your doctor and your health insurer. Medibank members can call 134 190.

Written by Editor Medibank

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