What expenses are there if I go into hospital?
Once you leave the hospital and the bills start arriving you need to know how to submit your claims.
There are usually two types of accounts that need to be paid: the hospital accounts (for accommodation, all that yummy food etc.), and the doctor’s accounts. Each of these are claimed slightly differently.
How do I claim hospital accounts?
If your cover has an excess, co-payments, or both, you should have already paid your part directly to the hospital.
The hospital then bills your health insurer directly for the remainder of the cost (as long as the procedure is not excluded from your cover). If the hospital sends you an account, ask them to send the bill directly to us.
If you’re admitted into a public hospital as a private patient, the public hospital may choose to charge more than the benefits that we pay. Public hospitals can do this because they’re not contracted to charge a set amount for a private patient. This doesn’t happen most of the time but we need to let you know in case it does. If the hospital charges more than the benefit that we pay, you’ll need to pay the amount on top of your excess and any co-payments that apply.
How do I claim doctor’s (medical) accounts?
Hospital cover also includes benefits for the Medical bills you receive from doctors as part of your hospital stay (as long as the treatment is not excluded from your cover). In some cases your doctor or specialist will bill Frank and Medicare directly, so the only account you will get from them will be for any out of pocket expenses.
If the doctor sends you the entire bill, you will need to submit the claim through Medicare using ‘two-way' claiming for Frank and Medicare to pay benefits.
If you haven’t paid the bill, Medicare will pay their benefit directly to the doctor and forward the account to Frank so that we can pay our benefit. If you have paid the account, Medicare will pay the benefit directly to you and forward the account to Frank so that we can pay our benefit. Once the doctor receives their payments, they'll send you a new account for any out-of-pocket expenses which you will need to pay.
If you have already claimed at Medicare and didn't use the two way claiming system, you can forward a copy of the Medicare benefit statement that you would have received to:
Important: In this case, we are unable to use the Medicare claims history as it is insufficient for processing. We are only able to use a copy of the Medicare benefit statements, however we don’t need a copy of the original doctor’s invoice.
What are out of pocket costs and why do they exist?
When you go into hospital as a private patient, your doctor will charge for their service. Health insurers pay medical benefits based on a set fee for specific services created by Medicare (known as the Medicare Schedule fee or MBS fee).
When you’re admitted to hospital, Medicare covers 75% of the MBS fee and your health insurer pays for the additional 25% (so the full MBS fee is covered) for the doctor’s service.
Doctors don’t have to charge this amount and sometimes they will choose to charge more than the MBS fee or the amount covered by your health insurer.
All of Frank's hospital covers come with Access Gap Cover through our partnership with The Australian Health Service Alliance (AHSA).
Providing you choose a doctor that participates in the program you can reduce or even eliminate any gap for medical fees when treated as an inpatient in hospital.
You can typically claim for Orthodontics via HICAPS or you can pay the account in full then submit a claim to us for the refund. If you’re claiming on Orthodontics, you’ll need to have the appropriate level of extras cover and serve the 12 month waiting period.
Frank pays benefits up to your annual limit and the lifetime limit on your level of cover. If you have received benefits for Orthodontics with another fund, these will count towards your lifetime limit.
Benefits vary based on your cover, to find out your annual and lifetime limit check out your fact sheet in the member area