Need even more help

[AaronS]

OK. So my wife has a massive ear ache in both ears and it's bad enough that we should probably get her checked out...maybe even tonight. How does the hospital billing work with insurance? Do we pay up front and then file a claim or do we get an MBS number for the insurance company to pay it directly?

[Guest The Pom Queen]

I have never had private insurance so not 100% but whenever I have been in hospital I have seen other patients just asked to pay the excess.

Hope she gets better soon and someone can give you a better answer.

[Guest Guest16631]

..............

If you get sent any doctors’ or specialists’ bills, you’ll need to claim from Medicare first. Then, bring the Medicare Statement of Benefits and any receipts or invoices to your private health provider................................ or send them your claim by mail

If you haven’t paid the account, Medicare and private health provider...................... will give you a cheque, made out to your doctor. Whatever remains unpaid from the account (i.e. what Medicare and private health provider didn’t pay) is what you pay to your doctor..................................hope this helps and your wife feels better soon...................

[Guest Guest16631]

...............little more info on emergency hospital visits.......................

 

Health fund hospital tables do not cover the medical fees and charges for

services provided in private hospital emergency departments. This means

that these fees are reimbursed as services to ‘not admitted patients’ by

Medicare at 85% of the MBS fee, as they are for a visit to your GP. If

tests are required in the emergency department (eg blood tests or x-rays),

the gap between the MBS fee and the amount charged is not covered by

any gap agreement or gap cover scheme your health fund may have for

 

 

hospital treatment.

[fleabo]

Phone your insurer - they will tell you the score.

 

But don't let that delay getting your partner checked out.

[Quoll]

OK. So my wife has a massive ear ache in both ears and it's bad enough that we should probably get her checked out...maybe even tonight. How does the hospital billing work with insurance? Do we pay up front and then file a claim or do we get an MBS number for the insurance company to pay it directly?

 

Are you on holiday or are you resident?

 

If you are resident then you rock up to A&E get it seen and go home (or whatever they tell you to do) no charge.

 

(If you have registered with a GP they often have access to an out of hours locum service in which case you would fork out for the GP consultation - usually around $100 out of hours and medicare will give you back about $60 if you present your bill to them)

 

If you are visiting from UK and it is considered necessary medical treatment then you rock up to A&E get it seen and go home (or whatever they tell you to do) no charge.

 

Private health insurance only comes into play if you venture into the private system - so you rock up to A&E, they say OMG you need your adenoids out, we can do it in July 2014 and you say no, I want it in December 2011 so you seek a specialist appointment through your GP, go and see your specialist who will charge you $120 (medicare will give you back about $50 if you are lucky), make the arrangements for the elective surgery in Dec 11, give your private health number and you will get a bill for the excess that they arent prepared to pay according to whatever your policy says.

 

Good luck with the ears