When you go to hospital you can expect at least 2 bills — one from the hospital and the other from your doctors and/or specialist. The hospital usually sends the bill directly to The Fund but you may receive the bill when you leave hospital.When would I get a bill from the hospital ?
You may get a bill from the hospital for many different reasons:
- The hospital hasn't confirmed if you are covered for the procedure
- The hospital doesn't have an agreement with The Fund
- You are within waiting periods for the procedure
- The procedure is to treat a pre-existing condition
- The procedure is excluded on your cover
- You are an out-patient when you go to hospital or a day facility/surgery
If you are not sure why you have been billed,
please contact us.
When you won't get a
bill from the hospital
You will not get a bill from the hospital where
you've served the waiting periods for your Hospital cover, your procedure is
covered and the hospital has an agreement with the Fund. In those instances all you'll need to pay is
your hospital excess.
What to do if you
get a doctor or specialist bill?
If you receive a bill from your doctor or
specialist, you'll need to claim from Medicare first. Then, send the Medicare
Statement of Benefits and any receipts or invoices to the Fund using our claim form.
If you haven't paid the account, Medicare and the fund
will give you a cheque, made out to your doctor. Whatever remains unpaid from
the account (i.e. what Medicare and the Fund hasn’t paid) is what you need to
pay to your doctor.