Private Health Insurance

Private health insurance coverage varies considerably from policy to policy, so the out of pocket costs associated with surgery vary for each patient. We endeavour to provide every patient with accurate Informed Financial Consent for their hospital treatment. As part of this we advise each patient to contact their health insurance company and the hospital where they will be treated to discuss the expected out of pocket costs of hospital treatment. For more information on Informed Financial Consent for privately insured patients please visit the Private Health Insurance Ombudsman's website. 

Private Health Insurance Hospital Excess or Co-Payment

Your hospital excess or co-payment is the amount of money that you have to pay if you are admitted to a private hospital. In some instances this is $0, in other instances it is $250 or $500 or more. Your health insurance fund will be able to advise you of the amount. 

Important: Private Health Insurance Exclusions and Restrictions

Does your private health insurance cover you for plastic surgery and accidents? If you have private health insurance it is important to look at the exclusions and fine print in your policy. 

1. Some private health insurance companies have an exclusion for accidents if you do not seek treatment within 72 hours of the injury. This means that if you have a "minor" accident and you decide to wait and see if your bruising/strain/sprain gets better that your private health insurance may refuse to cover the costs of any subsequent treatment. 

2. Some private health insurance companies have exclusions for joint replacement surgery. In some instances this may mean that you are not covered for joint stabilisation surgery or arthritis surgery on your hands. While you may have recognised that the exclusion meant you were not covered for a knee or hip joint replacement, the lack of coverage for hand surgery related to the joints can come as an unwelcome surprise. 

3. Some private health insurance companies have exclusions for plastic and reconstructive surgery. On first glance this might seem fine, if you think that "plastic surgery" means cosmetic surgery. However, plastic surgery involves skin grafts for burns, scar revision and microsurgical repairs of hand and finger injuries. 

As the Private Health Insurance Ombudsman's website states: "If your policy excludes or restricts Plastic and Reconstructive Surgery, this means there are over 1600 surgical procedures in the Medicare Schedule under the plastic and reconstructive category which your policy either does not cover or covers only to a limited extent. The procedures which you are not covered for can become clinically necessary at any stage of your life." 

For more information on private health insurance exclusions and restrictions please visit the Private Health Insurance Ombudsman website.