How to claim

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:

1. hospital accounts (for accommodation, all that yummy food etc.), and
2. medical accounts (for treatment received – you may receive an account from each doctor or treating specialist).

Each of these are claimed slightly differently.

How do I claim hospital accounts?

If your cover has an excess, you should have already paid this amount 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 difference, on top of your excess.

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 (provided the treatment is included on 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.

Important: If you’ve already claimed at Medicare and didn't use the Two-way form, we’ll need to see the Medicare Statement of Benefits you received to be able to process your medical claim. In this case, we can’t use your Medicare claims history, but the good news is we won’t need a copy of the original doctor’s invoice. To submit this type of medical claim via the Frank app, head to the claims section and follow the prompts to upload a photo or copy of your Medicare Statement of Benefits.

What are out-of-pocket costs and why do they exist?

When you go into hospital as a private patient, your doctor and other treating specialists will charge for their services. Health insurers pay medical benefits based on a set fee created by the Australian Government for specific services (known as the Medicare Benefits Schedule fee, MBS fee or ‘scheduled 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 your doctor or treating specialist is registered for and opts in to the Access Gap Cover scheme for the billing of your treatment, you can reduce or even eliminate any gap for medical fees when treated as an inpatient in hospital.

Find out more about Access Gap Cover.

Claiming extras

How do I claim extras expenses?

Claiming your extras benefits is easy! If your provider has an electronic claiming machine – which most do, you can claim on the spot.

Make sure you have your member card handy at the time of your appointment to tap your Frank digital card or swipe your physical card when paying your account. We'll pay the provider directly, so all you have to do is pay the difference.

If your provider doesn’t have these facilities or there is a problem processing your electronic claim, you'll need to pay your account upfront and claim using one of the following options:

1. Use the Frank app – simply take a photo of your receipt and upload it to the app to make a claim. Don't have it yet? Download the app today. Once your claim has been processed, your benefit will be paid into your nominated bank account.
2. Submit a claim online – log in to your secure member area to lodge a claim. This is the fastest way to receive your benefits if you need to make a manual claim. We’ll have the money in your account in 1-2 business days.

What if my provider doesn’t have an electronic claiming machine?

If the provider doesn't have an electronic claiming machine, you can pay the account in full then submit a claim via the Frank app or member area..

Claiming orthodontics

Thinking about corrective treatment for your teeth or jaw alignment? If you’re covered for orthodontics on your extras cover and have served the 12-month waiting period, you can typically claim via an electronic claiming machine at your provider or pay the account in full then submit a claim to Frank for the refund (see Claiming extras above).

Frank pays benefits up to your annual limit (or sub-limit) and the orthodontic lifetime limit on your level of cover. If you’ve switched to Frank and have received benefits for orthodontics with another fund, these will count towards your lifetime limit.

Ask your dentist or orthodontist for a cost estimate with your orthodontic treatment plan – this can help you work out your out-of-pocket costs.

Check out your fact sheet in the app or member area to see if you’re covered for orthodontics, what your lifetime limit and benefit limits are and how much you might get back. Benefits vary based on your cover.