What do I need to know before I go into hospital?

At Frank, we understand that going into hospital can be scary, confusing and sometimes stressful. When you go into hospital there will be bills from the hospital, your surgeon, anaesthetist and any other doctors involved in your admission. They all work differently, so there are important questions you should ask before you go into hospital.

Questions for your specialist

1. Which hospitals do you practice in?

This is important because the type of cover you have dictates the type of hospital you can be treated in.

If you are on Frank’s Basic Hospital – without the Some Private option – you will need your specialist to treat you in a public hospital.

If you are on Frank’s Basic with Some Private, Better or Best Hospital covers, you can be treated in any public hospital or any of Frank's participating private hospitals, provided your treatment is covered privately by your policy.

If you go to a hospital that is not a participating private hospital there will be additional charges that are not covered by Frank. Make sure you ask the hospital (or Frank) if the hospital has an agreement with us.

2. Are you registered with Frank Health Insurance (or Frank’s parent company GMHBA) for simplified billing? If so, will you be billing Frank directly?

This is important because it makes things easier for you! Simplified billing means the specialist sends the bill straight to Frank so you don’t need to worry about making a claim.

3. Will you be charging me an out of pocket expense?

There’s a limit to what Frank and Medicare will pay towards a doctor’s bill, but there's no limit to what a doctor can charge.

This means your doctor can choose to charge more than you’re covered for. To avoid any surprises, check with them to see if there will be any out of pocket expenses.

4. Will there be any other doctors billing me?

Any doctors that are involved in your hospital stay will bill for their costs separately to your specialist. Other doctors may include an assistant in your operation, an anaesthetist, pathologist, radiologist, etc.

These doctors may also bill us directly if they are registered for simplified billing but pathology and radiology fees will not receive the additional benefit. These doctors may charge an out of pocket expense, please check directly with them what these costs may be.

Some private hospitals only have single rooms and co-payments will apply

5. What are the Medicare Benefits Schedule (MBS) item numbers for my procedure?

These item numbers are helpful to have handy when you contact Frank.

We use them to make sure that your procedure is included on your level of cover and to estimate any benefits payable to you if the doctor hasn't already provided this information.

Questions for the hospital

1. Are you one of Frank’s participating private hospitals?

Frank has agreements with most private hospitals relating to billing, fees and benefits. These agreements are made through the Australian Regional Health Group (ARHG). It's important that your hospital is a participating private hospital to avoid additional costs to you.

The list is subject to change, so check with your hospital or with Frank before confirming your admission.

2. Will there be any additional charges that aren't covered by the participating private hospital agreement?

You’ll field the cost of things that are not required for your medical treatment (like the use of a TV or newspapers), so it’s important to check what these costs will be with the hospital.

There may also be a charge to you for medications prescribed when you leave hospital.

3. When will I need to pay my excess?

Most hospitals will expect payment of your excess on admission.

The excess on all of Frank's hospital covers is $500 per person per calendar year.

This excess is limited to a maximum of $1000 per couple or family membership per year.

4. I’m on Frank’s Better Hospital cover, can I have a single room if there are any available?

Frank’s Better Hospital only covers you in a shared room.

If you stay in a single room in a private hospital there will be an additional charge of $100 per day up to $700 per hospital stay. This is known as a co payment. The co payment is charged in addition to your excess and will apply each time you are admitted to a single room.

Questions for Frank

1. Am I covered in a private hospital, or a public one?

Frank has three levels of hospital cover: Basic, Better and Best.

Basic Hospital (without the Some Private option) only includes cover as a private patient in a shared room in a public hospital.

If you take out Frank’s Some Private option on Basic Hospital, Frank will cover you in a cushy private hospital for a few common services.

Better and Best Hospital include treatment in a public hospital as well as any of Frank’s participating private hospitals.

Check the exclusions on your cover carefully to make sure that you’re covered for the procedure you’re about to have.

2. Have I served my waiting periods?

If you have not served your waiting periods with Frank prior to your admission you may not be covered for any of your costs. You can double-check this in your online members area or by contacting Frank.

If you are within the first 24 months of your membership with Frank a benefit limitation period may apply. Contact us if you’re unsure whether this applies to you.

3. Does my cover include benefits for this procedure?

Some of Frank’s covers exclude certain services to help keep costs down.

All of Frank’s exclusions are listed on Frank's hospital cover pages. If it's excluded then you won’t be covered for that procedure.

4. Do I need to pay an excess?

An excess applies when you are admitted into hospital as a private patient.

This usually means you pay the first $500 that the hospital charges. This excess is only payable one per calendar year.

5. Am I covered for a single room?

With Frank’s Best Hospital, Essentials Bundle and Starter Bundles you’re covered for hospital accommodation costs in a single or shared room in a recognised participating private hospital for the services included in the cover.

On Better Hospital cover you can get a single room, but that privacy is going to cost you a little more. Co-payments of $100 per day (up to $700 per admission) apply for single room accommodation in private hospitals.

With Basic Hospital (Some Private) you’re covered for hospital accommodation costs in a single or shared room in a recognised participating private hospital for the services covered within a private hospital as part of the cover.

Basic Hospital provides cover for shared room accommodation only.

6. Are my payments up to date?

Before paying on your hospital or medical claims your Frank membership must be paid up to date.

The hospital will usually request that your membership is up to date before your admission so that they can ensure that your claim will be paid. To make sure you’re up to date with you payments check your members area or give us a call.