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Going to hospital

I am going to hospital. What should I know before going?
Going to hospital can be a daunting experience, many people are apprehensive so here are some tips that will help you best prepare for your admission and keep out-of-pocket expenses to a minimum.

Before you go to Hospital
Talk to your GP
Often your hospital admission starts with your GP. You will usually will have discussed your symptoms with your GP, s/he may have ordered tests and suggested that you need to see a specialist for your condition. This can be a worrying time but there are some questions that you should remember to ask your GP.
  • Why am I being referred to this particular specialist ?
  • Are there any other specialists that treat my condition ?
  • Is it possible to have an open referral so I can see the specialist of my choice ?
Check your health insurance policy
  • Check to see if your policy covers the procedure that may be required for your condition
  • Check that you have served any Waiting Periods associated with the treatment of your condition
Learn more about the specialist you are considering
  • Check if the specialist participates in our Gap Cover scheme. Click here to find out.
  • Call the specialist’s receptionist and ask for information regarding what out-of-pocket expenses to expect. If the specialist is a member of our Gap Cover Scheme it’s a good idea to mention this and ask if your procedure would be ‘no gap’.
  • Ask the receptionist which hospitals the specialist uses. Then check if these hospitals are in the Fund’s Agreement Hospitals' list which aim to minimise or eliminate hospital gap costs.
  • If you are concerned about the potential out-of-pocket expenses you may want to discuss this with your GP. You may want to use the Fund’s Gap Cover search tool (click here) to identify participating specialists in your area and discuss this list with your GP.

Questions to ask your specialist
  • What is your experience in treating this condition?
  • What are the risks of the procedure? 
  • What are the potential complications
  • Is there an alternative to surgery?
  • Can this procedure be done as day-surgery?
  • Will any other health professionals such as an assistant surgeon or anaesthetist be involved in the procedure? 
  • Ask for details about those providers and check if they participate in the funds Gap cover scheme and if not what their out-of-pocket fees are. 
    • You can go back to your primary specialist and ask if they will consider using other specialists who do participate in the Fund’s Gap Cover scheme or one with lower fees.
    • Ask your specialist to give you the Medicare Benefits Schedule item numbers for the required procedure. Call us on 1300 806 808 to make sure these items are covered by your policy and that you have served waiting periods.
Choose an Agreement Hospital to reduce or eliminate hospital gaps
  • The vast majority of private hospitals are Agreement Hospitals.
  • Identify which hospitals your specialist uses and book an Agreement Hospital to reduce or eliminate your out-of-pocket expenses.
What are 'Agreement Hospitals' and 'Day Facilities'?

We have negotiated agreements with the vast majority of private hospital and day facilities across Australia, many of which have agreed to our ‘No Gap’ scheme so that our Members pay as few out-of-pockets as possible. These are known as Agreement Hospitals.

To make sure you’re covered (or limit your out-of-pocket expenses as much as possible), we recommend that you go to an Agreement Hospital for your procedure. We also cover you in any Australian public hospital for any inclusions under your chosen hospital cover.

We recommend that you call us on 1300 806 808 before choosing your doctor, specialist or hospital to ensure you either pay no gap or minimise your gap.

What is a 'Non-Agreement Hospital'?

A Non-Agreement Hospital is a private hospital or day facility that does not have a contract with The Fund. If you choose to have your procedure done at a hospital that we do not have an agreement with, it is likely that you will need to pay significant out of pocket expenses at your own expense.

How do I find ‘no gap’ doctors and Hospitals?

To search our list of recognised providers or to find your most convenient Agreement Hospital and Access Gap Cover doctor, please go to the Members section here.

Hospital and doctors bills
Hospital bills

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.


Need some help?

If you still have questions,call us on 1300 806 808.

Transport Health Pty Ltd ABN 39 099 028 127 is a registered Health Benefits organisation.