
Get exclusive healthy living offers and guides
Straight to your inbox
Updated
We’re reader-supported and may be paid when you visit links to partner sites. We don’t compare all products in the market, but we’re working on it!
Going to hospital can be a stressful and confusing time and it’s vital that you find out if you’ll have to pay any out of pocket expenses beforehand. Knowing the exact amount that your treatment will cost is informed financial consent, and you’ll need to liaise with your doctor, your private health insurer and your hospital to work out your total expenses.
Informed financial consent refers to knowing how much your private medical bills will cost before you go in for treatment. Depending on your circumstances, some of the treatment costs might be covered by Medicare or your private health insurer, but anything left over will need to be covered out of your own pocket – this is known as a gap payment.
It’s important to ask your doctor, your health fund and your hospital about how much you will have to pay for treatment before you go under the knife. Doctors and hospitals must inform you of the total cost of treatment, preferably in writing, before you are admitted to hospital or receive treatment. This allows you to compare health services providers and possibly save money on out of pocket expenses.
If you’re scheduled to receive treatment as a private patient, as well as any questions and concerns you will have about your health, you’ll also want to know how much the procedure will cost. The Medicare Benefits Schedule (MBS) lists a set fee for every medical service, and Medicare covers 75% of that fee when you receive hospital treatment as a private patient. If you have adequate private health cover in place, your private health fund will cover the remaining 25%.
However, extra costs may arise if the specialist treating you, or other doctors involved in your treatment and care, charge more than the MBS fee. If the doctor or specialist is happy to use your health fund’s ‘gap cover arrangements’, your private health insurance can cover more than 25% of the MBS fee.
But it’s entirely up to the doctor’s discretion as to whether they use an insurer’s gap cover arrangements. If they decide not to use those arrangements, you’ll need to cover the fee gap out of your own pocket.
That’s why it’s important for you to get the full information on the cost of a procedure from your treating doctor, your health fund and your private hospital before you receive any treatment.
The Australian Government provides a handy checklist of questions you can ask to find out about any out of pocket expenses associated with your treatment.
As mentioned above, the Medicare Benefits Schedule (MBS) is produced by the Australian Government and lists a fee for every medical service. When you receive treatment as a private patient in a public or private hospital:
However, doctors and specialists have no obligation to charge you the MBS fee, so their fees may end up being more than the amount listed in the MBS. It’s also worth pointing out that when you are being treated in hospital there may be several specialists involved in your care, including a surgeon, an anaesthetist and a pathologist. With this in mind, there can be quite a large gap between the total fee charged for your procedure and the 75% MBS fee coverage provided by Medicare.
The gap refers to the difference between the total cost of medical or hospital expenses and the amount of that which is covered by Medicare and your private health insurance.
There are two types of gaps: hospital gaps and medical gaps.
The Private Health Insurance Ombudsman recommends taking the following steps if you receive a bill from your doctor that is much higher than anticipated:
Informed financial consent allows you to make the right decision about the medical care and treatment you receive. Make sure you ask all the right questions and find out exactly how much your treatment will cost before you go under the knife.
Find out how much a colonoscopy costs in Australia and how you can avoid paying heaps.
Find out how much veneers cost in Australia and how you can avoid being hit with a big bill.
Find out how much dentures cost in Australia and how you can get cover with mid-level health insurance.
Everything you need to know about weight surgery costs.
Find out more about the costs of egg freezing and how to get cover.
Find out how to get cheap health insurance for young people.
A single IVF treatment typically costs over $8,000 in Australia. Here’s how Medicare and private health insurance can help.
Finder research shows that Australians have just under one week to beat the health insurance price increase on 1 October.
The highest paid jobs in Australia ranked.
Winner, finalists and methodology for Finder Awards 2020 Best Health Insurance - Bronze (Hospital).
Get cover to suit your budget and lifestyle.
Great offers, promos, and deals for today.
Hospital, extras, or neither? Find out in 1 minute.
Compare visa-compliant OVHC today.