Hospital

Private hospital insurance covers you in the event you’re formally admitted into a private facility and are required to pay an excess. This is known as being an ‘inpatient’. The charges for your bed fees, medication, theatre etc. will all be billed directly to your health fund. 

If you do need to visit an emergency department attached to a private hospital prior to a potential admission, but you’re not admitted after being assessed, you'll be considered an 'outpatient', which means that you won’t be covered by health.com.au (or any other health insurer) for the emergency room fee. However, if you are subsequently admitted after being treated in the emergency room and pay your excess, you’ll receive a separate invoice for your emergency room treatment outside of your standard hospital inpatient invoices and any surgical fees incurred. 

As a definition, an outpatient service is something that has been performed outside of private hospital, without an admission being necessary. (a GP visit is the most common example of an outpatient service).   

If you find yourself significantly out-of-pocket for your emergency department fee, you may be eligible to claim a rebate under the Medicare Safety Net. 

If you attend an emergency room attached to a public hospital, this doesn’t incur a fee and will be fully covered by Medicare.