Private Health Insurance
There are many private insurance policies available and all with different levels of coverage. Therefore, it’s best to give your health fund a call prior to your admission and find out exactly what you are covered for and whether your policy includes any additional costs such as an excess or co-payments.
Before you call, you may also want to ask your doctor(s) for the item number(s) relating to your surgery.
Do I have to bill my private health insurer?
Epworth will submit a claim to your private health insurer for the cost of hospital related expenses.
Epworth will also submit claims for Department of Veterans Affairs (DVA) patients, WorkCover, TAC and other third party claims as long as a letter of liability is provided.
What is an excess or copayment?
A hospital excess (also known as a deductible) is an annual out-of-pocket expense you pay when you are admitted to hospital before you can claim a benefit under your private health insurance policy.
The hospital collects this excess on behalf of your health insurer. You only need to pay hospital excess once per person per year when admitted to hospital.
A co-payment is a fixed amount you agree to pay each time your health insurer pays hospital benefits for you under your health insurance policy. For hospital admissions, a co-payment is payable for each day of hospitalisation up to a maximum annual amount.
Excess and co-payment amounts can vary depending on your health insurance policy. For more details about applicable excess and co-payment amounts payable under your policy, please contact your health insurance provider.
What are item numbers, illness codes or clinical categories?
Item numbers refer to the Medicare Benefits Schedule (MBS) list of health professional services.
Clinical categories set out the hospital treatments (MBS item numbers) that are, and are not, covered under each health insurance policy.
How do I contact my health fund?
Contacts for registered Australian health funds can be found here: https://www.privatehealth.gov.au/dynamic/insurer
What if I'm self-insured?
If you do not have private health insurance an estimate of your admission costs will be calculated for you. You are required to pay your estimated account prior to or on your admission. The actual cost incurred may differ from the estimate, due to a change in treatment or a longer stay in hospital than originally planned. If treatment costs exceed the estimated amount, you will be asked to pay the difference before going home. For further information, please contact the patient service centre of your admitting hospital.