What Do I Need To Know When Claiming On My Private Health Insurance?

Knowing what you are entitled to claim for when you sick or injured and need to go to hospital can be confusing. Understanding the details of your policy is critical when joining to know what you’re entitled to which can very base on your fund and if you have a premium of cheap health insurance policy. Another option is simply to call up your health fund to discuss the policy you have with them.

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* The price shown is per week and applies to a {LIFESTAGE} living in VIC with a $500 excess. It excludes LHC loading and includes a Base Tier Government Rebate

If you are admitted to a participating private hospital the hospital may either require you to pay upfront minus the amount the health fund will pay or will send the bill straight to the health insurance company. In this second circumstance, the health fund will pay the amount stated in the policy and sent through the outstanding amount payable by the patient.

The amount the health fund may pay may vary by variables that include where you’re treated:

  • A public vs private hospital
  • A participating vs non-participating private hospital to that fund

It’s worth planning ahead so if you do need to visit a hospital for an emergency you know where you want to be treated to ensure you receive a good level of treatment without a large out-of-pocket expense. If you have a cheap health insurance policy you may need to re-evaluate it if doesn’t allow you to be treated in the hospital you want to be treated in if you do get sick/injured.

When a doctor or specialist treats you in hospital they will send the bill directly to your health insurance company. If they send the bill to you, you will need to take the account to Medicare and fill out a Medicare Two Way claim form to be able to claim.

When you are claiming extras cover there are various ways to claim. The most convenient way is to claim is using the electronic claims and payment system (HICAPS). This way the claim can be processed on the spot at your appointment and you just have to pay the difference as the private health insurance company will pay the provider directly. This can be done when visiting most optometrists, dentists, physiotherapists, chiropractors, osteopaths, dieticians and podiatrists.

However, not all providers have this facility so another way to claim is by post. All you have to do is fill out a claim form and attached the original receipts and send it to your health insurance company. The health insurance company will then normally send you a cheque or credit your nominated bank account if you have already paid for the service. If the service has not yet been paid for a cheque will be sent directly to the provider.

You can also claim online by just logging into your health care providers’ website and registering all the details. Make sure your receipt has all the relevant details on it including the item number. Some private health insurance companies will also require you to send the original receipt to them once your online application is done to be able to finalise and process it.

Things you need to know before claiming are:

  • Make sure your contributions are paid up to the date of the service
  • All waiting periods but of been served before you can claim
  • You must submit an original copy of the account which includes the date of service, the item number, the type of service and the cost
  • You are not able to lodge a claim before the service is provided
  • The policyholder’s or nominated signature must appear on the claim form

At Frank Private Health Insurance we make sure you know what’s covered and what’s not. We make claiming easy and are here to assist you every step of the way. Ensure you don’t just get cheap health insurance but the right health cover for you with Frank!

We don’t play favourites. Choose your own extras provider (as long as they’re registered in their field of service of course)

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