Hospital costs explained
Hospital bills include the inpatient stuff that specialists' fees don't, like an operating theatre, nursing care, bed and food. Here we'll get into controlling your costs on different levels of Hospital cover.
Where to start
First, check your Hospital Product Sheet to see if the hospital treatment you’re planning is marked as 'covered' or 'restricted'.
If it's covered
Ask your specialist if they can treat you at an agreement private hospital (a hospital we have a contract with). This includes most of the private hospitals around Australia.
If they can, and will, your insurance should cover most of the costs. That said, it's important to ask the hospital directly about any additional expenses you may have. They can be related to your care, like high-cost medicines or robotic surgery. Or non-medical stuff like TV, internet or phone use.
If it's restricted
Ask your specialist which hospitals they work out of, and how much they charge private patients for your treatment. With restricted services, a public hospital is likely to be the most cost-efficient option.
Here's how it works:
Public hospitals
If your specialist can treat you in a public hospital as a private patient, ask if the hospital charges the government set fee for that service. If they do, we pay your hospital bill (apart from your excess, if applicable).
If the hospital charges private patients more than government set fee, you'll have to pay the difference. This can vary a lot, so be clear on this before you agree to any treatment.
At a glance
We pay – Accommodation (up to the government fee for a shared room)
You pay – Any excess on your cover and the balance of your accommodation costs
Private hospitals
If you're treated at a private hospital for a restricted service, you're likely to have significant out-of-pocket costs.
As with public hospitals, we pay up to the set government fee for your hospital accommodation. But a private hospital will probably charge more than that.
At a private hospital you'll also have to pay for any operating theatre, intensive care or neonatal intensive care costs, because they're not included in the accommodation cost (which they are at public hospitals).
Again, you need to understand those costs before you consent to treatment to avoid bill shock later.
At a glance
We pay – Accommodation (up to the government fee for a shared room)
You pay – Any excess on your cover, the balance of your accommodation costs, and any other costs involved in your hospital stay
Any questions?
If you have any questions about choosing a hospital for covered or restricted services, please give us a call on 1300 727 538.
How to choose a specialist
What Teachers Health members need to know to get value from their Hospital cover and avoid bill shock.
Going to hospital guide
Find out how get the most from your Teachers Health cover, control your costs, and be an active participant in your healthcare.