Your hospital stay Everything you need to know
How to plan your hospital stay Simple steps to help you get the most from your HBF hospital cover. 1 Understand your cover in advance 2 Visit your GP for a referral 3 Visit your specialist 4 HBF Member Plus hospitals 5 Talk to HBF to check cover details 6 Confirm your treatment estimate 7 Get treated in hospital 8 Leave hospital and settle claims 9 Make a recovery to full health
We re here to help you At HBF, we know that planning a hospital stay means you want clear information to ensure you get the most value out of your hospital cover. That way, you can focus on the important part: getting back to health. This step by step guide takes you through all the important things you need to know about going to hospital. In particular, we want to be sure you understand your benefits and how any out-of-pocket expenses work. That way you can approach your treatment with peace of mind. At any time, please feel free to call HBF from hospital costs to claims and recovery, we re always here to help you. Before your hospital stay Understand your cover in advance... 2 Who covers what?... 2 How the medical gap works... 3 Closing the gap... 3 Things to know about going to hospital... 4 Visit your GP... 4 Choose your specialist... 4 Visit your specialist... 4 Call HBF for a quote... 5 Informed financial consent... 5 HBF Member Plus hospitals... 6 Understand your hospital type... 6 More great HBF Member Plus hospital benefits... 7 During your hospital stay While you are in hospital... 8 Common out-of-pocket expenses... 8 Things not covered during your stay...10 Before you are discharged...10 After your hospital stay Once you re home and recovering...12 Understanding your bills...12 Easy ways to claim...13 Getting back on track...13 1
Before your hospital stay Understand your cover in advance It s good to know your HBF private hospital cover is here to help you access the very best treatment and care, so you can get your health back on track and enjoy life. So it s important when you re going to hospital, to understand how private health insurance cover works. At HBF we want to make sure you know this in advance, so you can avoid cost surprises over unexpected out-of-pocket expenses. Who covers what? The following information will help you distinguish between what Medicare covers and what private health insurance covers. Medicare provides benefits towards: GP and specialist visits blood tests medical scans pharmaceuticals listed on the PBS public hospital accommodation, treatment and services Private health insurance provides benefits towards: ambulance transport dental, optical, physiotherapy, chiropractor and other services known as extras hearing aids and other appliances Private inpatient hospital accommodation, treatment and services Medicare and private health insurance will both pay a benefit for: private inpatient hospital treatment and services What does inpatient mean? An inpatient is someone who has been formally admitted to hospital for treatment. If you have treatment in a hospital (for example, a procedure or doctor s appointment) this may not be considered inpatient hospital treatment. This is classed as outpatient hospital treatment, for which your private health insurance cannot pay a benefit. Please call us to get a quote if you re unsure. 2
How the medical gap works In general, if you choose to be treated as a private patient in a private hospital, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee, and HBF pays the remaining 25%. Some specialists (doctors, surgeons, anaesthetists) can choose to charge more than the MBS fee. If this happens, there may be a gap, which is the difference between the MBS and the specialist s fee. To help manage your out-of-pocket costs, it s important to understand that your specialist s fee will fall into one of three categories: No-gap specialists: Because they re fully covered by Medicare and HBF, you can keep your costs low by choosing an HBF preferred provider, as you won t have anything to pay (apart from an excess or any product exclusions). Known-gap specialists: They have agreed to charge a fixed amount above the MBS fee. HBF pays some of this known gap but you will need to pay the balance yourself. No agreement specialists: They have opted not to participate in any gap agreement. If you use a no agreement provider, you ll pay all costs charged above the MBS fee. Before your hospital stay Paid by HBF Fixed portion paid by HBF. You pay the balance You pay the balance Medical Gap Your out-of-pocket costs Total medical cost 25% paid by HBF 75% paid by Medicare 25% paid by HBF 75% paid by Medicare 25% paid by HBF 75% paid by Medicare Medicare Benefits Schedule (MBS) Fee The MBS fee is the standard fee or set amount (by the Federal Govt) for your medical service as a private patient. No-gap specialist Known-gap specialist No agreement specialist Closing the gap HBF helps you reduce hospital out-of-pocket gaps in several ways: Choose an HBF no-gap specialist. Call us for a quote if you re unsure about which category your specialist falls into, and your out-of-pocket costs. Take out HBF GapSaver: a smart way to minimise out-of-pocket expenses, with benefits accruing year after year. 3
Before your hospital stay Things to know about going to hospital At HBF we want to make sure you understand the steps you will most likely take when you are going to hospital. Of course, you can call us at any time along the way if you have questions. With our great value hospital cover behind you, you can follow the process below with peace of mind. Visit your GP Hospital treatments most often begin with a visit to your GP. Discuss your condition and if applicable your GP will refer you to a specialist for treatment. Remember, you are entitled to choose your specialist, so ask for a few recommendations. Choose your specialist HBF has a large network of fully covered specialists. Choosing to be treated by one of them means your out-of-pocket expenses are kept to a minimum. If you accept your GP s referral to a specialist who isn t fully covered, contact us before your treatment to find out your likely out-of-pocket expenses. Visit your specialist At your consultation, the specialist will assess your condition and, if necessary, discuss your options for hospital treatment. You should receive a written cost estimate for your procedure, including specialist s fees, plus any additional fees (eg. anaesthetist, assistant surgeon). If an estimate for additional fees isn t provided, ask your specialist for one. Ask your specialist what hospital they will treat you at. 4
Call HBF for a quote If you ve just learnt you need to go to hospital, we strongly suggest you call us before being admitted to hospital, so you can be sure you re covered for the treatment. You can also obtain a benefit quote online via myhbf. We will check all details including any waiting periods, restrictions, minimum benefits, if excess co-payments apply, which hospital you should go to and how to minimise any out-of-pocket expenses. To ensure we can give you accurate advice, please call us with your written cost estimate, and we will ask you questions about your: Before your hospital stay Specialist s name Anaesthetist s name Hospital name Hospital admission date Day or overnight patient Item numbers for your treatment Specialist fee for your treatment Any other fees estimated Informed financial consent Remember, you re legally entitled to know what your costs might be before going into hospital. If your hospital stay involves any out-ofpocket hospital charges, the hospital (whether public or private) and your specialist must disclose the cost and obtain your agreement in writing before your admission. This could include fees from anaesthetists, assistant surgeons, pathologists or radiologists. The only time informed consent is not required is in an emergency where you are unconscious or otherwise unable to give consent. In these circumstances consent is deemed to have been given. 5
Before your hospital stay HBF Member Plus hospitals To help you get the best care and the best value, HBF has special arrangements with a large network of Member Plus private hospitals across Australia. That means you can avoid or limit your costs by choosing treatment here. In an HBF Member Plus hospital you ll be covered for accommodation and theatre fees for all agreed services on your policy. By choosing a fully covered specialist and going to a Member Plus hospital, you have the peace of mind that potential out-of-pocket costs will be minimised or eliminated. Find a full list of Member Plus hospitals by searching under: Find a Provider at hbf.com.au or call us on 133 423. Understand your hospital type HBF Member Plus private hospital Go to one and you ll get the best value from your cover. You ll be covered for most services, with the least out-of-pocket expenses. Non Member Plus private hospital You can still choose to be treated here, but be aware that you may incur significant out-of-pocket costs. Check with HBF before your stay. Public hospital You can choose to be treated here as a public or private patient. But remember, you won t always avoid public hospital waiting lists, get a private room, or have continuity of care with the same doctor. We recommend that you call us first before making a booking to confirm that your hospital gives you the confidence of full cover. 6
More great HBF Member Plus hospital benefits Someone to stay with you If you need a parent, partner or carer to stay overnight with you in hospital, HBF will fully cover costs for a boarder if their presence is needed for the management of your condition. Costs covered include meals and accommodation in your room. Before your hospital stay The little extras As a patient, you will have free access to a daily newspaper, local phone calls and free-to-air TV. Ambulance transfers While you re staying in hospital as a private patient, you re covered for all medically necessary inter-hospital ambulance transfers, to or from a private hospital. 7
During your hospital stay While you are in hospital With all the information you now have, and knowing you ve been able to choose your doctor and your hospital, you can go ahead and sign your admission forms with confidence. While a hospital stay can be daunting, you should be assured that with HBF you have access to the best possible medical care to treat your condition and help you back on the road to health. Common out-of-pocket expenses While every hospital works a little differently, remember there will always be some expenses you will incur. To ensure no surprises, be aware that you may have to pay the following: Excess If you ve opted to reduce your premiums by adding an excess, you may need to pay this for an inpatient hospital stay. Private room If you re not covered for private accommodation but your selected hospital only has private rooms available, you may need to pay the additional cost between a shared room rate and the private room rate. Private room availability is at the discretion of your hospital. Pharmacy You may be billed for the cost of pharmaceuticals. Pathology and radiology tests If you need diagnostic tests, some hospitals services, such as x-rays and blood tests, will be billed to you. You can ask your specialist in advance if this is likely to apply to you. In-hospital allied health services If you require services such as physiotherapy or speech therapy, these services may be included in the hospital charges, or may be covered on your policy. 8
Surgical implanted prostheses Aids to recovery Hospital facilities and incidentals Some joint, cataract or heart prostheses are fully covered, and some may attract an out-of-pocket expense. Check with your surgeon and with HBF. You may be required to pay for items to assist in your recovery, such as slings or compression stockings. You may be charged for access to and usage of facilities like phone, wi-fi, television and pay-tv channels. During your hospital stay Medical costs You may be charged fees by certain specialists involved in your hospital treatment, like a surgical assistant or anaesthetist, that are not fully covered by HBF or eligible for a rebate from Medicare. Your cost estimate before treatment should outline these. Ongoing care needs Sometimes, you may have ongoing care needs such as wound dressing or IV antibiotics after you re discharged from hospital. These will be billed to you directly. 9
During your hospital stay Things not covered during your stay Remember, there will always be items that are not covered, and you should be aware of these in advance: Outpatient services If you re admitted as a private inpatient, you ll be covered for the services listed in your chosen level of hospital cover. If you receive treatment as an outpatient (ie. you are not admitted), in most instances you will not be covered by private health insurance. If eligible, these services may be claimed from Medicare. Costs for treatments not recognised by Medicare There are a few hospital procedures, such as cosmetic surgery, that are not eligible for a Medicare rebate or covered by private health insurance. Treatment before your waiting periods are served Be aware of any waiting periods on your policy. HBF can advise you on these. You will not be covered for treatment you have before this time. In general, a waiting period of 12 months applies to pre-existing conditions, maternity and IVF, and a 2 month waiting period exists for general hospital treatments/ palliative care, psychiatric and rehabilitation services. Restricted or excluded treatment If you receive treatment that is specifically restricted or excluded on your policy as a private patient, you will incur significant out-of-pocket expenses. Please contact HBF prior to your hospital stay to ensure your treatment is covered. Before you are discharged Ensure you have written instructions about managing your post-hospital care. Understand any medications and instructions for taking them. Know who to contact if you experience problems related to your treatment. Make a follow up appointment with your specialist. Request a medical certificate if you require one for work. Organise for a family member or friend to take you home from hospital. 10
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After your hospital stay Once you re home and recovering At HBF, we want you to focus on getting back to optimum health after a hospital stay. So we aim to make your recovery as stress-free as possible, including claiming and following up on any bills. Please be assured that wherever we can, we will take care of paperwork and payments, saving you the added worry. Understanding your bills Doctors and hospitals often bill independently and may send multiple bills depending on how many services they have provided. These bills could come at different times often weeks or even months after your hospital stay. Depending on your specialist, the hospital you were treated in and your cover, you may receive a number of bills. Hospital bills These cover accommodation, nursing, theatre costs, food, additional items such as pressure stockings, pharmaceuticals, prostheses and incidentals. Any excess or fees for items not covered under your policy or at a non-member Plus Hospital will be billed directly to you. Specialist bills These may come from your specialist and other providers such as an anaesthetist, pathologist, radiologist, assistant surgeon or allied health professionals involved in your hospital treatment and stay. Remember: You will only receive bills related to your hospital treatment if your specialists charge fees in excess of the MBS Fee, or don t have an agreement with HBF. To cover some of the out-of-pocket costs, you ll need to lodge these bills with Medicare first. If you re not sure why you have been billed, please call us. 12
Easy ways to claim Claim online Save time by using the myhbf member self service portal. You can set up a user account easily using your member number. Simply login to www.hbf.com.au/myhbf then click on Submit health claim and upload your original account or receipts. If you have claimed from Medicare for in-hospital medical services please also include the Medicare Statement of Benefit. After your hospital stay Straight to your bank account Don t forget to enter or confirm your bank account details on all claims so we can credit your benefits directly to your nominated account. If we don t have your bank details, we ll issue a cheque. To set up or confirm your bank details go to www.hbf.com.au/myhbf Claim form Download a claim form from www.hbf.com.au Complete it and post to: HBF, GPO Box 1440, Perth WA 6839 Statement of benefits After your hospital and medical claims (from doctors and specialists) have been processed, we ll send you statements showing what has been paid on your behalf. Please check that these details are correct and contact us straight away if you have any queries. Getting back on track It s great to know that HBF is not only there for you when you re in hospital, but we also offer many ways to support you on your recovery journey. Health support programs If you suffer from a chronic or long term illness, we know it can be difficult to stay well outside of hospital. You may also find it difficult to access practical health programs, or to find relevant information about your specific health condition. For more information please view our range of health programs. Healthy living programs As an HBF member with Extras and Wellness cover, you can take advantage of our wide range of healthy living programs. Options include joining a registered yoga class or being part of a pilates program. 13
Ni hao! Go to hbf.com.au Visit a branch Mon to Fri: 9am to 5pm Sat: 9am to 12.30pm* Call us 133 423 Mon to Fri: 7am to 6pm Sat: 8am to 2pm Postal address GPO Box C101 Perth 6839 Stay in touch Find us at HBF Health Metropolitan branches Perth 96 William St Belmont Belmont Forum Booragoon * Garden City Cannington * Carousel Fremantle Corner Market St and High St Mall Mandurah 32 Pinjarra Rd Midland * Midland Gate Morley * Galleria Rockingham * Rockingham Subiaco 142 Rokeby Rd Success Cockburn Gateway We speak your language If English is not your first language, our multilingual team is fluent in many languages including Mandarin, Cantonese and Hindi. Call us on 1300 735 137. Hillarys Whitford City Innaloo Innaloo Joondalup * Lakeside Joondalup Shopping City Karrinyup * Karrinyup Regional branches Albany 21 Albany Hwy Bunbury 12 Arthur St Busselton 2/90-92 Queen St Geraldton Northgate Even the healthiest bodies need looking after. HBF is the Official Health Partner of WA s favourite teams, the Fremantle Dockers and the West Coast Eagles. HBF Health Limited ABN 11 126 884 786. The information in this brochure is correct at time of print. Minor changes may have occurred since that date. If major changes occur, the brochure will be replaced. Details of any minor changes can be obtained from HBF on request. C105418 HI-911 01/10/15