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 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, forward the Medicare benefit statement that you would have got when you claimed along with a claim form to:

Frank Health Insurance, Reply Paid 69, Geelong VIC 3220

Important: In this case, we need the original Medicare benefit statement, not a copy. 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.

Frank pays an additional 20% as part of their Gap Cover to help reduce your medical gap. If your doctor charges above 120% of the MBS fee you will need to pay the gap (difference between 120% of the MBS fee and the total bill) which is an out of pocket cost.

Your doctor or specialist should have discussed any of pockets with you before the procedure, so there shouldn’t be any nasty surprises.

Claiming extras

How do I claim extras expenses?

A lot of providers use a HICAPS machine (which is like an EFTPOS machine) which makes claiming really easy.

You just swipe your membership card via HICAPS when you receive a service and your health insurer pays the provider directly. Then you get charged the remainder of the bill.

What if my provider doesn’t have HICAPS?

If the provider doesn't have HICAPS, you can pay the account in full then submit a claim to us for the refund. With Frank you can usually lodge the claim online or you may need to submit a claim form with your receipt.

Claiming Orthodontics

If you have Some Extras

Claim up to 50% or 80% (depending on your cover) of the cost of treatment, up to a maximum of $300 per year. You can continue to claim for orthodontic treatment until you reach the lifetime limit of $1,050 as long as the treatment is ongoing. When the treatment stops, so do Frank’s refunds. Orthodontic benefits sit within a total dental annual limit (covering general, preventative and major dental services).

If you have Lots Extras

Claim up to 50% or 80% (depending on your cover) of the cost of treatment, up to an annual limit (which is based on the number of years you have held Frank Lots Extras cover).

  • 1 – 3 years of membership = claim up to $700 per calendar year
  • 4 years of membership = claim up to $800 per calendar year
  • 5 or more years of membership = claim up to $900 per calendar year

You can continue to claim for orthodontic treatment until you reach the lifetime limit of $2900 as long as the treatment is ongoing. When the treatment stops, so do Frank’s refunds. Orthodontic benefits sit within a total dental annual limit (covering general, preventative and major dental services).

If you have a Starter Bundle

Claim up to 60% of the cost of treatment up to a maximum of $300 per calendar year (combined with the Major Dental annual limit). You can continue to claim for orthodontic treatment until you reach the lifetime limit of $1,100 as long as the treatment is ongoing. When the treatment stops, so do Frank's refunds.

If you have an Essentials Bundle

Claim up to 60% of the cost of treatment up to a maximum of $500 per calendar year. You can continue to claim for orthodontic treatment until you reach the lifetime limit of $1,700 as long as the treatment is ongoing. When the treatment stops, so do Frank's refunds.