Health fund Q & A
If you would like to discuss your health insurance with us please call our patient services staff on (03) 8545 8000.
It is important that you provide all your health fund details on the Patient Registration Form (MR005) prior to admission to facilitate a smoother admission. You will be given a patient information pack containing the form by your specialist or IVF Patient Coordinator.
Does my insurance cover me at MSPH?
You will be covered for your procedure if you have top or intermediate level of cover and have served the qualifying period (usually 12 months). If you have changed to a higher level of cover, your health insurance fund will still cover you at the lower level for 12 months. If you are on a level of cover which has an excess, and you have not paid it in full in a 12 month period, the excess applies. Most funds have a co-payment for day surgery. We ask that you pay the excess and co-payment on admission prior to your treatment. MSPH will claim the hospital theatre and bed fee directly from your fund on your behalf.
I haven’t been in my fund for more than 1 year
All funds have a pre-existing rule which means they may treat your condition as pre-existing. Therefore, we may need you to pay a deposit on the day of your admission, as it may take up to 3 months for us to receive a decision from your fund as to whether or not you are covered. The deposit will be refunded to you if your health fund agrees to cover you for your procedure.
Alternatively you may obtain a pre-existing certificate from your fund prior to your admission. This form needs to be completed by the Doctor who referred you to your specialist. On completion, forward the form to your fund stating your date of admission, procedure and a request for written approval to be faxed to MSPH on (03) 8545 8080. Without written approval we will request that you pay the deposit as mentioned.
What if I have transferred to a new fund?
If you have transferred to a new fund you will need to clarify that a clearance certificate has been received from your previous fund.
I only have basic cover, am I covered?
Your fund will cover you at MSPH for your bed fee only. You will have to pay the theatre fee. If you have an excess or co-payment this will need to be paid prior to your fund providing cover. Please call us to clarify the fee for you.
IVF - Will I be covered?
Private health insurance funds have different waiting periods for IVF patients. Generally they range from 2 – 3 years, depending on your fund. Contact your health insurance fund for more information and clarification.
Overseas visitors and health insurance
You may have to be a member for more than 18 months to be fully covered by your health fund. Written approval is required if your fund is an overseas company. Without written approval you will need to pay and receipts will be issued to enable you to claim.
Please check with your health fund if you are unsure or have any queries. Some health fund websites are listed below:
Medibank Private - www.medibank.com.au
BUPA - www.bupa.com.au
NIB Healthfunds Ltd - www.nib.com.au
GMHBA Health Cover - www.gmhba.com.au
Australian Unity - www.australianunity.com.au
HCF Health and Life Insurance - www.hcf.com.au
Latrobe Health Services - www.latrobehealth.com.au
Paying your account
Your anaesthetist will forward an account to you for his/her services, which is claimable from Medicare and your private health insurance. An out of pocket expense may be incurred.
Your surgeon –
- will forward an account for his/her services
- may have an assistant from whom you will receive an account
- may send a specimen to pathology for testing from whom you may also receive an account
These are all claimable from Medicare and your health fund. Again, you may incur an out of pocket expense. If you do not have private health insurance you can only claim these accounts through Medicare.
The hospital fees incurred for your procedure must be paid prior to your treatment at the time of admission. If you have private health insurance, any excess and/or co-payment must be paid upon admission. If you have not served the waiting period or your level of cover is not sufficient, then you must pay the non-covered portion of the hospital fees upon admission. Patients who do not settle their accounts at the time of admission will risk having their treatment cancelled. MSPH only accepts payments in the form of VISA, Mastercard, EFTPOS and cash. Cheques are not accepted.