Health funds and the cost of your hospital stay

Private health insurance

If you have private health cover you will need to ask your health fund if your hospital admission is covered, and if there are any co-payments or excess that will apply to this admission.

You need to know:

  • does your policy have any restrictions
  • does your policy cover the cost of your hospital stay (including theatre fees and prostheses)
  • are you covered if you need inpatient rehabilitation
  • are there any out of pocket expenses (i.e. excess or co-payments) that are payable on admission.

Please note: if you have been a member of your health fund for less than 12 months you may be liable for the total hospital account.

Self-insured/overseas insurance

If you are self-insured (uninsured), please contact the business office on tel: 03 9928 6644 for an estimated cost of your hospital stay. You will be required to pay any costs prior to admission, and we reserve the right to refuse admission if payment is not received. Patients with overseas insurance may be considered uninsured at the time of admission.

WorkSafe/TAC-covered patients

If you are covered by WorkSafe or TAC you need to confirm your entitlement to this before admission. Please supply us with a copy of your letter of authorisation for payment from either WorkSafe or TAC.

Veterans

Veterans and Department of Veterans’ Affairs (DVA) patients are asked to bring their DVA card with them on the day of admission and present it to staff at reception. Find out more about our services for veterans.

Health funds and claiming the cost of medicines

Costs of medications you are taking PRIOR to your admission and dispensed by our pharmacy while you are an inpatient AND medications supplied on discharge are NOT covered by your health fund. Those costs are payable on discharge.

In some situations, there may be a gap payable for certain prosthetic items. This will be discussed with you prior to surgery.

Health funds have different rules about managing High Cost Drugs. Most will not fund anything that does not have Therapeutic Goods Administration (TGA) approval. Please note: some medicines are approved for certain conditions but not others.

We keep up-to-date with the current rules of each health fund, and can apply to your fund on your behalf to seek funding for High Cost Drugs. We lodge submissions from your doctor and indicate the need for the medication and the cost. The fund then informs us if they will cover the cost of the medication and how much they will compensate.

If the health fund does not cover the cost of the medication, then the cost will be the responsibility of the patient.

You can also contact your health fund directly to request additional funding for the medications. You may also speak to your doctor to see if there are any alternative medications on the PBS schedule that are just as effective for your condition.

If you have questions, contact our continuum of care managers:

  • St Vincent’s Private Hospital Fitzroy tel: 03 9411 7394
  • St Vincent’s Private Hospital East Melbourne tel: 03 9928 6832
  • St Vincent’s Private Hospital Kew tel: 03 9928 6832.