Going to hospital can be daunting. To help make it simple, here’s our guide to the stuff you need to consider before, during and after you leave.
Before you book
If you haven’t already, live chat with us or call 134 246 weekdays, 8am – 7pm (AEST/AEDT) to let us know you’re going to hospital – we’ll check:
- Your cover includes the treatments you’re looking to have and you’ve served your waiting periods.
- Your premium payments are up to date.
- Any excess or co-payment you’ll need to pay on admission.
To make your claim as smooth as possible, we need some information from your doctor or hospital.
For the answers you need, print the off the questions below to take to your next hospital appointment at ahm.com.au/7questions
7 Questions for your specialist before going to hospital
1. What are all the specific MBS item numbers for my procedure?
2. Will my doctor/surgeon be participating in GapCover for each claim forming part of my treatment?
3. Will other specialists involved in my treatment, eg assistant surgeon or anaesthetist, participate in GapCover for each claim forming part of my treatment?
Tip: Your surgeon can provide their contact details so you can check directly with them.
4. Which hospital will I be treated in? Is the hospital public or private?
If you have chosen a non-partner private hospital we’ll only pay a limited benefit and you may be significantly out-of-pocket. Call us to discuss this on 134 246 weekdays, 8am – 7pm (AEST/AEDT)
5. Can I get a full written breakdown of fees for my treatment from each treating doctor or specialist?
This is called your Informed Financial Consent. It's your right to know how much your in-hospital treatment will cost BEFORE you get admitted. For more information, read our Informed Financial Consent guide.
6. If I need prosthesis, what out-of-pocket expenses could there be?
7. If I need radiology or pathology, what out-of-pocket expenses could there be?
While you're at hospital
Find out how to pay your out-of-pocket expenses.
Medicare or ahm don’t pay towards out-of-pocket expenses.
Your doctor may ask for some of these to be paid before you get admitted and then bill you any other costs later – or you may be asked to pay 100% of your out-of-pocket expenses upfront.
Either way, they will issue invoices for you to claim on after you leave hospital.
After you leave hospital
Claiming - what happens next?
Once you’ve left hospital, any costs you agreed to in your Informed Financial Consent will be billed and you will be issued with invoices for your out-of-pocket expenses. (See above.)
- If you’ve received a bill from your doctor(s) or recognised provider(s) for any inpatient hospital treatment, you’ll need to fill in both a Medicare Claim Form and a Two-way Claim Form to submit your claim to Medicare.
- Medicare will process your form and pass on the required information to us. If you have not paid for the services, you will receive a cheque from Medicare followed by a cheque from ahm. You will need to forward these to the doctor together with any gap amount.
- Doctors participating in GapCover will bill ahm directly. ahm will claim from Medicare on your behalf.
- Hospitals will bill ahm directly for the cost of your admission to the hospital. They will bill you separately for your excess/co-payment, discharge pharmacy and any other stuff ahm doesn't pay towards like TV, telephone or newspapers etc.
Other important stuff
- Make sure you get any information you may need to refer to afterwards from your specialists.
- Don’t forget to get any medical certificates you may need for work.
For help and more information on any part of this process, live chat with us or call 134 246 weekdays, 8am – 7pm (AEST/AEDT).