Public vs. private

Back to all news 23 December 2016

Going into a public hospital and claiming on your private health insurance

At TUH we receive feedback from members who have been admitted at public hospitals and then are approached by the hospital to sign a form to claim the episode through their private health insurance. Often there are enticements to encourage you to claim. We have even heard from a member saying she was denied admittance to a public hospital unless she signed a 'private patient election form' and paid out-of-pocket fees up front.

We want to make it absolutely clear that public hospitals cannot force you to elect to be treated as a private patient and cannot refuse to treat you if you do not sign the election.

Every Australian who is registered with Medicare can access the public hospital system at no cost. You are already paying for this service by paying a Medicare Levy which goes towards providing you with health services in a public hospital. If you claim on your private health insurance you are effectively contributing twice. 

The amount of money that private health insurers are paying to the public system is on the increase and will in turn affect the premium you pay. You are not required to use your private health insurance when being admitted to a public hospital if you don’t wish to.

If you go to a public hospital, you’ll be asked to sign the ‘patient election form’, which tells the hospital whether you want to be admitted as a private or public patient.

Before you choose, the hospital and your doctor should tell you what your out-of-pocket costs will be. This is called informed financial consent. For major treatment, this information should be provided in writing. Your surgeon should be able to advise who else will be treating you and how you can contact the other doctors to seek fee information from them. In some circumstances, such as emergency admissions, it will not be possible for your doctor to obtain informed financial consent before the service is provided. 

If you elect to be treated as a private patient in a public hospital, TUH will pay minimal benefits set out by the Government for your accommodation.

If you choose to stay in a private room for an overnight stay, we'll pay a fixed benefit in addition to the shared room minimum benefit. Note that in public hospitals, private rooms are generally allocated to people who medically need them.

If the hospital accommodation charges are greater than the TUH benefit, you'll be required to pay the balance as an out-of-pocket expense. If you are admitted as a private patient, you may also incur out-of-pocket medical expenses and/or co-payments if you are a nursing home type patient. The hospital should let you know what these expenses will be before you elect to be a private patient.

So it’s very important that you have all the facts and give careful consideration before signing any documentation if you are being admitted privately into a public hospital. If you have an appointment to see a specialist about possible surgery, give us a ring first. We can give you some hints and tips to help make you a savvy user of your private health cover.