Going to Hospital
What to expect: a guide for MBF members
If you have to go to hospital, we want you to be able to focus on getting well. It's important to be well prepared before you go to hospital and to be involved in, and informed about, your treatment. This information will assist you to make this happen.
- Going to hospital? Here's a checklist to assist you!
- After you have left hospital
- Common healthcare terms
Going to hospital? Here's a checklist to assist you!
Step 1. Questions to ask your specialist prior to going to hospital:
- Could you please explain, in simple terms, the treatment I am having?
- Which hospital do you recommend? Why?
- When should I expect to go to hospital?
- How long do you expect me to be in hospital?
- What is my expected recovery time?
- What are the possible complications associated with my proposed treatment?
- What can I do, prior to hospital, to reduce my risk for complications?
- Should I stop taking any of my medications prior to going to hospital? If so, how long before?
- Will I have restrictions regarding my everyday activities when I go home (eg driving, lifting heavy objects)? If so, how long will I need assistance?
- Will a surgically-implanted prosthesis be used in my surgery? (This question may or may not apply to you.)
- If so, why has this prosthesis been recommended for my surgery?
- Is there a gap associated with my prosthesis?
If so, how much? $ _______________
- Is there another prosthetic that is just as suitable and has no gap?
- What is/are the Medicare item number(s) for the treatment you are planning for me? ______________
- I am an MBF member. Will you use the Medical Gap Scheme or charge me a medical gap?
If so, how much? $ _______________
- What other doctors will be involved in my treatment?
- Will these doctors involved in my treatment use the Medical Gap Scheme or charge me a medical gap? If so, how much?
Assistant surgeon ____________
Anaesthetist ________________
Radiology _____________
Pathology ____________
Other medical specialists ______________
Step 2. Review your hospital cover
You can find this information from several MBF resources:
- Link and review hospital cover
- MBF member enquiries 131 137
- MBF corporate member enquiries 1300 653 525
- Visit your nearest MBF Centre
Step 3. Questions to ask MBF prior to going to hospital:
- I plan to be admitted to __________________ (name of your hospital)
- Is my hospital an MBF Network Hospital?
- If no, how will this impact my hospital bills? Find more information here.
- Am I covered for the treatment I am about to have?
- What is my Excess?
- What is my Co-payment?
Step 4. Preparing to be admitted
Make a list of any queries you may have about your treatment and hospital stay. Make sure you discuss them with your specialist and any other health professionals.
Take a friend or family member with you to the doctor, pre-admission clinic and on admission to hospital. Another pair of ears can be invaluable in trying to remember important details!
Things to pack and take with you:
- Your MBF Member Card.
- Your Medicare details.
- Any doctors' letters regarding your stay.
- Your informed financial consent form from your specialist (applies to prostheses too).
- The pre-admission packet from the hospital (if you received one).
- Any relevant x-rays or medical images (eg ultrasound).
- Your regular medications. Ensure your doctor knows about them. He or she can advise which medications may not be suitable.
- A written list of all medications and over-the-counter tablets including vitamins or other natural substances you are currently taking.
- Any other items requested by the hospital.
Remember: do not take valuables or large sums of money.
Step 5. Prior to leaving hospital
You may not feel completely recovered when you are discharged from hospital and may require ongoing treatment, rest and recovery.
So it's important that you, your family and other support people understand what's involved when you leave.
Before you leave hospital, ask:
- What medicines you may need, when and how they should be taken, and if they will be supplied or whether you will need to have prescriptions filled.
- When you can resume normal activities, what you may need to avoid and any other precautions you should be taking.
- When you should see your specialist next and make an appointment, if possible.
- Who you should call if you experience complications, and how to contact them.
- If you will need home help, hospital or medical equipment or other home treatment. If so, ask the hospital staff how you can organise this.
Remember to take your medications home with you!
Typically, you will need to sign a completed claim form as well as pay for any excess, co-payments or out-of-pocket expenses upon leaving.
After you have left hospital
Your extras cover
If you need ongoing treatment, such as physiotherapy, after your hospital stay and you hold a level of MBF extras cover, you may wish to contact us to talk about the benefits available to you.
Further, if your cover includes MBF Living Well Programs and/or complementary therapies, we may be able to assist you with the cost of weight management, quit smoking programs, naturopathy or remedial massage amongst other services. Find out more.
Don't forget that, with MBF AutoClaim, you can claim some services, including physiotherapy, dental and optical, on-the-spot by swiping your MBF Member Card.
How to claim
MBF offers several resources to assist you.
- You can find useful information, additional trusted websites and forms from 'Your medical bills' on mbf.com.au.
- MBF member enquiries 131 137
- MBF corporate member enquiries 1300 653 525
- Visit your nearest MBF Centre
Common health cover terms
Gap
A 'gap' is the difference between what the hospital and/or your doctor or other healthcare professional charges, and the benefits paid by Medicare and MBF - in other words, how much you have to pay yourself.
There are several different types of gaps. The most common is the 'medical gap'. This relates to fees you are charged for services you receive from doctors (eg surgeon, assistant surgeon, anaesthetist, radiologist, pathologist) while you are in hospital. Remember, you may not see every one of them personally.
(Neither MBF nor any other health fund covers doctor's charges for out-of-hospital visits, for example, consultations in the doctor's rooms.)
Medical charges
Medical charges are those made by your doctors and other healthcare professionals (such as the assistant surgeon, anaesthetist and radiologist) while you're in hospital. Some may be involved in your care 'behind the scenes', and you may not meet all the doctors involved in your care, but you may receive separate bills from each of them.
MBF, like all health funds, only pays a benefit for in-patient hospital treatment. For example, MBF does not cover consultations with your specialist in his or her rooms. Generally, where Medicare does not pay a medical benefit associated with in-patient admissions, no benefit is payable by MBF.
Medical gap, the Medicare Schedule of Fees and the Medical Gap Scheme
The Commonwealth Government sets the amount they will reimburse for doctors' charges for the purposes of paying Medicare benefits. This is known as the Medicare Benefits Schedule Fee ('MBS'). For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
If you are treated by a doctor who charges above the MBS, this will create an expense not covered by either Medicare or MBF. As the law prevents MBF from paying any amount charged by your doctor above the MBS (unless there is an agreement in place between your doctor and MBF or your doctor uses the Medical Gap Scheme), this difference becomes the 'medical gap' and you will be required to pay this out of your own pocket.
However, if your doctor participates in the Medical Gap Scheme (that is, agrees to accept the Medical Gap scheme schedule of benefits as full settlement of their account for your treatment, you will have no 'medical gap' to pay for that doctor's charge.
There are more than 5,600 such medical gap doctors nationally. However, we cannot guarantee a participating medical gap doctor in every area, or that he or she will treat every patient on a no medical gap basis.
So, before going to hospital, always ask your doctor:
- to explain all the costs involved in your treatment; and
- whether he or she will participate in the Medical Gap Scheme for your treatment.
Find if your doctor is participating in the Medical Gap Scheme.
Also, please be aware that it is quite possible that not every doctor involved in your hospital treatment, eg anaesthetist, radiologist, pathologist, assistant surgeon, is a medical gap doctor. So you may have to pay gaps for their services.
Please note: where Medicare does not pay a benefit for in-patient admissions (eg for cosmetic surgery), or the service is excluded under your level of cover, or you have not served the relevant waiting periods, no benefit is payable by MBF.
Excess
An Excess is an amount you agree to pay should you need to go to hospital. You pay it only once per person, to a maximum of twice per membership, in a calendar year. Generally, the higher your Excess, the lower your premium.
Co-payment
A co-payment refers to the amount you pay toward the cost of your hospital treatment. It is payable in addition to any out-of-pocket expense you may incur. A co-payment may apply each time you are admitted to a hospital or day surgery. You should check your level of cover to confirm your co-payment.
These terms are also explained in the complete copy of the MBF Healthcare Cover Guidelines.
