Going to the hospital is stressful enough without the confusing jargon. Whether it’s a planned admission or out of the blue, here’s the simple, no-nonsense rundown on what to expect.
You might’ve seen your GP, got a referral and met with your specialist. Now it’s time to get your head around using your hospital cover. We’ll walk you through what to expect and what to do next. And if you need a hand, we’re here to help.
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Hospital costs
Things like your room and surgery fees are usually billed straight to Frank, so you don’t need to chase those up. You’ll just pay any excess or out‑of‑pocket costs before you go in.
Medical costs
Your doctor’s or specialist’s fees are shared between Medicare and Frank. If they charge more than the Medicare Benefits Schedule (MBS) fee, you may need to pay the difference (this is called a gap). Some doctors use Access Gap Cover, which can reduce or cap these costs.
Because costs can vary, it’s worth asking your specialist for a quote before treatment (this is called Informed Financial Consent). If you need help, the Frank team is happy to chat through everything, just ask your specialist which Medicare Benefits Schedule (MBS) item numbers they’ll use to bill so we can give you the most accurate info.
What happens in an emergency?If your symptoms are serious or urgent, call 000 or head straight to your nearest emergency department.
Frank hospital policies include Emergency Ambulance Transport, so you’re covered if you need it.
It’s also important to know how hospital cover works if you’re treated in a private hospital emergency department. Learn more about what’s covered in an emergency.
What you’re covered for depends on the type and level of cover you have. You can check your cover fact sheet in your member area or app, or contact Frank if you’d like help understanding your cover.
Frank hospital policies include Emergency Ambulance Transport, so you’re covered for the lights and sirens if you need it.
Eligible Frank members with hospital cover may be able to access health support programs through Frank such as Hospital in the Home or Rehab in the Home. Contact Frank to check your eligibility, or you can ask your treating doctor or discharge coordinator at the hospital about a referral.
Telehealth services are also available to eligible Frank members.
Hospital benefits only apply once you’re admitted as a private patient for services that are included on your cover. Services before or after your stay, like private emergency department visits, outpatient tests, discharge medications, or specialist consultations, aren’t covered under hospital cover.
It’s also important to check for any restrictions and exclusions on your policy, as some treatments or services may not be included. If you’re unsure what your cover includes, contact Frank, we’re here to help.
Yes, you can upgrade your hospital cover if your current policy doesn’t include the treatment you need. However, waiting periods will apply for any new services added before you can claim.
A 12‑month waiting period generally applies to treatment for pre‑existing conditions, while other treatments may have shorter waiting periods. Upgrading can still be a good option for the future. We recommend reviewing your cover and any waiting periods before making changes, contact Frank if you need any help.
Restrictions help keep health insurance premiums more affordable. For restricted services, benefits are limited to the minimum set by the Australian Government. This typically covers accommodation as a private patient in a shared room at a public hospital.
It doesn’t cover the cost of a private room in a public hospital, any accommodation in a private hospital, or theatre fees. If you choose to be treated in a private hospital for a restricted service, you may need to pay significant out‑of‑pocket costs.
Hospital visits typically include out‑of‑pocket costs, along with any excess on your policy.
To avoid any surprises, we recommend checking your cover before your admission. You should also speak with your specialist about informed financial consent so you understand any expected costs upfront before going ahead with treatment.
An out‑of‑pocket cost (also known as a gap) is the amount you pay for inpatient treatment that isn’t fully covered by Medicare and your private health insurance.
These costs can pop-up if your specialist charges above the Medicare Benefits Schedule (MBS) fee, your procedure isn’t included in your level of cover, or if an excess applies to your policy.
An excess is the amount you may need to pay towards a hospital admission as a private patient.
All Frank hospital covers include an excess, which helps keep your premiums (what you pay for your policy) lower. Any excess that applies is capped, so you’ll only pay up to the maximum amount once per person each calendar year.
MBS item numbers refer to specific Medicare services and the scheduled fees set by the Australian Government, which determine how much the Government pays toward your care. They help determine if your procedure is covered under your policy and what benefits you’re likely to receive. Contact Frank if you need help.
Yes — there may be other doctors involved in your care, such as your anaesthetist, pathologist, radiologist or an assistant surgeon.
Each provider bills separately, so you may receive more than one bill. Some doctors may bill Frank directly, while others may send the bill to you first. How this works can vary depending on the provider.
These costs can include out-of-pocket expenses, so it’s a good idea to ask each provider for an estimate of their fees before treatment (this is called Informed Financial Consent).
As a private patient, you have a range of options when planning your hospital stay:
If you get the bill directly from your doctor. Here’s how to sort it out:
If you go to a hospital Frank doesn’t have an agreement with, we’ll still help cover the cost, but only up to the standard rate as set by the Australian Government. Because these hospitals usually charge more than this standard rate, you’ll likely face higher out-of-pocket costs.
Keep in mind, you may also have to pay:
There are a few simple ways to help manage your hospital costs and avoid surprises:
You can also use the Australian Government’s Medical Costs Finder to see typical fee ranges for common private procedures and get an idea of potential out‑of‑pocket costs.
Self‑advocacy means speaking up about your needs and staying informed about your recovery. Here are some simple ways to do that:
Advocating for yourself helps you stay safe, informed, and confident throughout your recovery.
Because sometimes your needs might change a little, you have a $500 freedom limit to claim on your 7 included extras services.
Get an extra $50 to claim on your freedom limit each full calendar year, with a maximum of $200 after 4 years of continual cover.
Because sometimes your needs might change a little, you have a $700 freedom limit to claim on your 11 included extras services.
Plus an additional Optical limit. You can claim 100% back on optical up to your $150 annual limit.
Get an extra $100 to claim on your freedom limit (excludes optical) each full calendar year, with a maximum of $400 after 4 years of continual cover. Your loyalty benefit will be available on 1 January after you've completed one full membership year.
Step 1. Check you're covered