More and more members are telling us that public hospitals are actively pressuring them to be admitted as a private patient. Do you know your rights when you’re asked the question “Do you have private hospital cover?”
If you have HIF Hospital cover, you’ve made a wise choice. Firstly, you avoid being placed on the public hospital waiting list queue which can be very long for elective surgery and can significantly impact your quality of life.
Secondly, with your HIF Private Hospital cover you can choose your doctor and hospital to ensure that you get access to the best care and facilities. However, you may find yourself confronting the prospect of being admitted to a public hospital, perhaps in the case of an emergency.
Here is a quick guide on your options and what it means to be admitted as a public patient in a public hospital versus electing to be treated as a private patient.
So what are my options?
As an HIF member with Hospital cover, you have the right to choose whether to be treated as a public or private patient in a public hospital. Your choice may involve you considering your level of Hospital cover, the type of treatment you need, how urgent it is and whether or not you can or would like to choose your doctor.
What does it mean to be a public patient?
If you’re an Australian resident or an ‘eligible person’ (e.g. from a country with a reciprocal healthcare agreement) and you choose to be admitted to a public hospital as a public patient, under Medicare you’ll receive care at no charge including accommodation, doctors’ services, diagnostic tests, medications and meals.
However, being admitted to a public hospital as a public patient means you’ll be treated by a hospital appointed doctor or a number of doctors, so you don’t get to choose.
What does it mean to be a private patient in a public hospital?
A key benefit of having HIF Hospital cover means that you can choose whether you want to be treated as a public or private patient in a public hospital.
Remember - in the event of an emergency, after treatment in an emergency department, you’ll automatically be admitted to a public hospital, so you don’t need to provide your HIF Hospital cover details at that point.
If you’re going to have an extended stay in hospital though, or you need additional surgery or ongoing medical treatment, your HIF Hospital cover allows you to elect to be a private patient and choose your own doctor either in a public hospital or a private hospital. And importantly, you can avoid the public hospital system waiting lists.
Let’s break it down…
| | Private patient in a
private hospital | Private patient in a
public hospital | Public patient in a
public hospital |
|---|
| How quickly will I be treated? | Elective
Straight away (provided you've served your waiting periods).
Emergency
You'll receive immediate treatment for urgent or life threatening conditions. | Elective
As soon as a spot becomes available (provided you've served your waiting periods).
Emergency
You'll receive immediate treatment for urgent or life threatening conditions. | Elective
You'll go on a waiting list and you could be waiting for weeks (even months, and over a year in some cases).
Emergency
You'll receive immediate treatment for urgent or life threatening conditions. |
| Do I get to choose my own doctor? | Yes, unless it's an emergency and your chosen doctor isn't available. | Yes, providing your chosen doctor is eligible to work in that public hospital and it's not an emergency. | No, you'll be treated by whichever doctor is appointed by the hospital. |
| Do I get to choose which hospital I go to? | Yes, providing your chosen hospital can accommodate you and the required facilities are available. | Yes, providing your chosen hospital can accommodate you and the required facilities are available. | No, you'll be treated by whichever doctor is appointed by the hospital. |
| Can I get a private room? | Yes, if one is available. (Out-of-pocket expenses may apply if you don't have the right level of HIF Hospital cover). | Yes, if one is available. Other patients may have priority depending on their medical needs. | Possibly, but only if available and generally only if it's medically necessary. |
| Do I have to pay for my hospital accommodation? | No, the only expenses you'll need to cover are your hospital excess (if applicable) and an accommodation co-payment if you're in a private room and you are not covered for that. | You may need to cover your hospital excess (if applicable) and your personal expenses such as TV hire (this might be negotiable with the hospital). | No, but you may have to pay for personal expenses such as TV hire, telephone calls or meals for an overnight boarder (e.g. your partner or parent). |
Important note: Any waiting periods, restrictions or exclusions on your HIF Hospital cover still apply if you’re admitted as a private patient in a public hospital. Please ensure you have read and retained our Product Disclosure Statement to ensure the cover you have is suitable for your needs.
How does admission differ for public and private patients in a public hospital?
Upon admission to a public hospital, the staff will explain the process to you and ask if you’d like to be admitted as a public or private patient. If you elect to be treated as a private patient, you’ll need to sign an election form which will detail all the associated costs.
As such, it’s important to ensure that you receive everything you’re paying for, including the doctor of your choice and a private room (if you’ve requested one and if the public hospital has one available). Alternatively, if you choose to be treated as a public patient, you will be asked to complete an admission form and provide your Medicare details.
At the end of the day, your decision should be based on what’s in your best interests. Having HIF Hospital cover will give you more choice but if you’re happy using the public system then you shouldn’t feel pressured to provide your HIF Hospital cover details.
It’s also important to note that you may incur out-of-pocket expenses if you use your private health cover in a public hospital – expenses that would otherwise have been fully covered under Medicare, such as excess payments (if applicable), plus any gaps that your doctor may charge for your treatment. So under some circumstances it might be more financially advantageous to be admitted as a public patient. But remember, you’ll lose your ability to choose your doctor.
Keep in mind there are significant benefits in having HIF Hospital cover, even though there may be chance an emergency circumstance arises where the public hospital’s Emergency Department is your best option.
Planning a hospital stay in the near future?
If you have any questions about what to expect when you’re admitted to a public or private hospital, don’t hesitate to get in touch and we’ll be happy to talk you through it. You can also request a medical benefit estimate prior to admission by completing our Hospital and Medical Estimate Request Form.