Where do out-of-pocket costs come from when I’m admitted to hospital?
- Procedures or treatment that is not covered by Medicare
If the procedure or treatment that you are receiving in a hospital cannot be claimed under Medicare, then your Private Hospital Insurance won’t apply either. You will have substantial out-of-pocket expenses for these procedures. Non-Therapeutic Cosmetic surgery is the common procedure this refers to.
- Admission to a non-contracted Private Hospital
If you are admitted for a procedure to a Private Hospital that Westfund does not have a contract with then, we will pay shared room Public Hospital benefits towards the accommodation for your stay. Substantial out-of-pocket expenses will apply. You can check Westfund’s contracted Private Hospitals on our Find a Hospital page.
- Hospital or Medical costs for out-patient treatment or Private Hospital Emergency Department Fees
Private Hospital cover only covers you for in-patient services. This means when you are admitted to a hospital, not when you are treated at an emergency department or a GP surgery.
- Medical, Pathology and Radiology services
While admitted to hospital you may have a doctor operate on you with an anaesthetist to partner them as well as radiology, pathology and other diagnostic tests. Medicare pays 75% of the Commonwealth Medicare Benefits Schedule (CMBS) fee while Westfund pays the additional 25% of the CMBS fee. If the provider of these services charges more than the CMBS fee, then this becomes an out-of-pocket expense to you as the patient. The exception to this is when the provider participates in Westfund’s Access Gap Cover. For more information on our Access Gap Cover page.
- Additional Services in Hospital
You are not covered for television hire, the internet, purchase of newspapers or hospital administration fees on discharge. Westfund member advantages may assist with some of these costs depending on your level of cover and the reason for your hospitalisation. More details are available on our Member Advantages page.