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 your hospital admission
To make your claim as smooth as possible, we will need some information from your doctor or hospital.
Check you’ve got all the info you need. We suggest asking your specialist these seven questions, to make sure you have everything you need for a Hospital Cover Check from us before your hospital admission.
Ask us for a Hospital Cover Check
When you've got your hospital admission and procedure details, fill in our Hospital Cover Check form. We’ll email a summary of your cover and what to expect.
This will include:
- Whether your cover includes the treatments you’re looking to have
- How much you can expect to get back from ahm and Medicare
- How claiming works
- Whether you’ve served any necessary waiting periods
- Whether your premium payments are up to date
- Any excess or co-payment you’ll need to pay on admission
The Hospital Cover Check will not include the specific amount of any gaps you may need to pay such as for specialists. Ask your specialists for this information using these seven questions
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, chat with us or call 134 246 weekdays, 8am – 7pm (AEST/AEDT).