Going to Hospital

Going to hospital can be scary enough, let alone trying to understand how your cover works and the fees involved. If you’re feeling a little lost or confused regarding the way your coverage works for your upcoming hospital visit, you’re most certainly not alone.

The below article is designed to help you understand your hospital cover, and will ensure you’re feeling good once the day comes to head on in.

Before we chat about your hospital visit, you’ll just need to confirm a couple of things:

  • Do you have an MBS Item number? Whether you’re having your appendix out or finally getting that new leg, the government has set an MBS (five digit) item number to identify the that particular procedure. Have a chat to your surgeon and grab all the item numbers involved, as our conversation won’t get too far without it!
  • When are you going in? Even if you don’t have an exact date, it’ll be helpful if you can let us know if you’re planning on going in tomorrow, next week or next year. This will assist us in ensuring all your waiting periods are served when the day arrives.
  • Where are you going? Do you have a hospital in mind? Or are you still weighing up a couple of options? Once you’ve got the name of the facility you’re heading into, we can check it’s on our (huge) list of agreement hospitals, so you can be sure we’re able to cover you for your stay.

No idea which hospital you’re going to? Private or Public all a little overwhelming?

Your GP and surgeon are probably the best people to have a chat to. Most of the time your chosen surgeon will work out of one or two select hospitals, narrowing it down and making it a little easier for you.

We have contracts with the vast majority of Private Hospitals in Australia, which means all you have to pay for your stay is the excess. It still might be worth a check in with them to make sure there’s nothing extra to pay (TV, extra comfort, a significant other boarding with you etc.)

Aside from the hospital, it is also important to get a quote from your surgeon and anaesthetist for any potential out of pocket costs they may be charging. To help avoid or eliminate any large out of pocket costs, we allow the use of the Access Gap cover scheme, which can often reduce or even eliminate the out of pocket costs associated with having a surgery in private hospital. Not only that, but it will also mean the practitioner will send all the invoices to us directly, preventing you from having to handle them so you can focus on the most important thing, your recovery!

Talk to your surgeon about access gap billing during your next appointment.

Going to hospital guide 


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. 



Have you heard the word?

On 1 July 2021, health.com.au will join forces with Frank Health Insurance.

Learn more about how this may affect your Hospital cover here.