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All the lingo you need to know Show content
What does it all mean? Show content
When it comes to medical treatment, it can feel like everyone is speaking a different language. Here’s your quick guide to what it all means.
Specialist: A doctor who has further training in a specific field of medicine. They may be a surgeon (who performs operations) or a physician (who treats conditions with the use of medicine). Examples of specialists include Cardiologists who look after the heart, Oncologists who treat cancer and Orthopaedic surgeons who operate on bones.
Anaesthetist: A doctor who is responsible for administering anaesthetist to patients for medical treatment. They provide general anaesthetist (which makes the patient unconscious) or local anaesthetist (which numbs a specific area while the patient is awake).
Admitted: Being admitted to hospital means you are being treated as an ‘inpatient’ as opposed to an ‘outpatient’ or in the emergency room. In most circumstances, people admitted to hospital will stay at least overnight.
The gap: The Medicare Benefits Schedule (MBS) is a list of medical procedures and a suggested amount doctors should charge for each, as recommended by the Federal Government (think of it like a recommended retail price). When you have an operation, Medicare will pay 75% of the MBS fee and health insurers pay the other 25%. Because the MBS is only a recommended fee though, many doctors charge above it – leaving a ‘gap’ between what is paid for you and the fee you’ve been charged.
Access Gap Cover Scheme: CUA Health may pay for some of the gap or even the entire gap for you if your doctor will treat you under the Access Gap Cover Scheme. It’s important to ask your specialist before making arrangements with the hospital if they will treat you under the Scheme as it’s voluntary for them to do so. If they choose not to treat you under the Scheme, you’re able to ask for a specialist who will.
The Access Gap Cover Scheme also makes claiming a breeze – having CUA Health and your hospital work together to take care of everything for you. If you’re treated under the Scheme, you’ll sign a claim form on admission and you may never even see a doctor’s bill.
What are all the fees, and what do I pay? Show content
When you’re admitted to hospital for an operation, there are a number of fees involved. If your procedure is covered under your CUA Health policy, a lot of it will be taken care of for you.
Breakdown of fees
Specialist fees: This is the fee charged by the doctor who treats you
Anaesthetist fees: If you need general or local anaesthetist for a procedure, your anaesthetist will charge fees for their service
Hospital fees: Can included things like the cost of your accommodation, the operating theatre, intensive care or labour ward
Excess: Is a fixed amount you pay once in exchange for lower premium costs. It does not apply to dependants
What you have to pay for
CUA Health has agreements with a number of hospitals across Australia. In these hospitals all you have to pay are your excess or co-payment plus any gap charged by your doctor. If you ask your specialist to treat you under the Access Gap Cover Scheme, the gap will be reduced or eliminated.
Visiting a specialist Show content
What happens when I visit a specialist? Show content
If you have a medical problem (unless in an emergency situation), your GP may refer you to a specialist. Your specialist will assess your condition and recommend treatment, which may require surgery and/or being admitted to hospital. If you are required to go to hospital, your specialist will work with you to decide the date and which hospital you’ll be treated at.
This initial appointment is not covered by Hospital cover, however Medicare may cover part of this bill.
Before you go to hospital Show content
What should I do before I go to hospital? Show content
Before you have any treatment, you have the right to know what expenses you may have to pay (what’s known as Informed Financial Consent).
Things to ask your specialist include:
- Can you and any other doctors involved treat me under the Access Gap Cover Scheme?
- Will there be any out-of-pocket expenses and if so, how much? (Ask for a written quote.)
- Can you provide me with the relevant Medicare Benefits Scheme (MBS) item numbers?
- If you’re getting prosthesis (i.e. hip and knee joint replacements, artificial heart valves, pacemaker devices and intra-ocular lenses for cataract surgery): What expenses are involved?
Call CUA Health on 1300 499 260 and ask:
- Is my treatment covered under my policy?
- How much of my procedure and hospital visit is covered?
- How much will my excess be?
- Have I served my waiting period?
- Are my premiums paid up to date?
On the day Show content
What happens when I arrive at the hospital? Show content
When you arrive at the hospital, you’ll be asked to sign yourself in at the admissions desk. The hospital will ask for your private health insurance information and they’ll call us to confirm your cover. You’ll then be asked to pay your excess directly to the hospital.
Rehabilitation at Home Show content
Rehabilitation at Home Show content
There is no place like home for patients who are recovering from surgery. Hospital stays are often extended when you require rehabilitation for a medical condition or post-surgery. This can be inconvenient as most people want to get home as soon as they can.
There is growing evidence that for many people, home rehabilitation works as well or better than in-hospital rehabilitation1
For eligible members and with your doctor’s approval, we can coordinate services such as nursing care, physiotherapy, occupational therapy and personal care to get you back into familiar surroundings and on the road to independence sooner.
What is Rehabilitation at Home?
This program helps you return home from the hospital sooner, by providing home-based support in place of a rehabilitation hospital stay. Services are tailored to your individual requirements, and may include nursing, physiotherapy, occupational therapy and personal care.
Benefits of Rehabilitation at Home
- expert in-home care
- feeling supported both physically and emotionally
- reduced strain on partners and carers
- not having to travel for some medical appointments
- getting home to family and pets
- reduces the need for hospital admissions
- a greater sense of control over your recovery
How does Rehabilitation at Home work?
You’ll receive the kind of support you would receive in hospital, while in the comfort of your own home. This program is coordinated by one of our health partners, Remedy Healthcare, an experienced provider of home and community-based care.
Your Rehab at Home coordinator will work closely with your doctor and hospital treating team to tailor a program specific to your needs that provides practical and convenient rehabilitation services following a wide range of surgical procedures and for medical conditions including:
- joint replacements
- cardiac conditions
- neurological conditions
- mobility problems and falls
- respiratory conditions
- spinal conditions
Are you eligible for Rehabilitation at Home?
To access our Rehabilitation at Home program, you need to
- hold an appropriate level of private hospital cover with CUA Health Insurance, and
- have completed any waiting periods that apply
To check your eligibility, please contact us on 1300 499 260
1 Buhagiar MA, Naylor JM, Harris IA, Xuan W, Kohler F, Wright R, Fortunato R. Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee ArthroplastyThe HIHO Randomized Clinical Trial. JAMA. 2017;317(10):1037–1046. doi:10.1001/jama.2017.1224
Making a claim Show content
How do I make a hospital claim? Show content
If your doctor treats you under the Access Gap Cover Scheme, in most cases you’ll never even see a doctor’s bill. If you aren’t being treated under the Scheme, any medical account you receive should be submitted to Medicare along with a two-way claim form. This will then be sent to CUA Health for processing. All you will need to pay is your co-payment or excess.
For your hospital accommodation, your hospital will deal directly with us. We’ll take care of all the details – so you only need to focus on getting better.
A copy of the Medicare Two-way Claim form can be found here.
Things to know about making a claim
- You must have served relevant waiting periods
- Your premiums payments must be up to date
- You can’t claim until after the service has been provided and paid for (you cannot claim for a procedure prior to it being provided)
- Claims must be lodged within two years from the date the service was provided
What happens if Show content
Your stay is extended or you need more procedures done while in hospital? Show content
For peace of mind, all CUA Health Hospital Cover options have a capped excess, so if your stay is extended, you won’t have to worry about accruing a huge medical bill. If you’re having additional procedures during the same admission, these same excess caps apply. Please refer to your Product Summary for information regarding your excess payments.
If need to stay longer or need more procedures, the hospital will call us to ensure you’re covered. Remember to still ask your doctor to treat you under the Access Gap Cover Scheme and if there will be any out of pocket expenses for you.
You have to return to hospital because of complications? Show content
Hospital excess are capped at once per person per calendar year. If you're re-admitted to hospital in the same year (for the same or a different condition), you won't have to pay another excess.
You go to the emergency room at a private hospital? Show content
CUA Health Hospital Cover doesn’t cover any treatment in an Emergency Department. If you need to visit an Emergency Department, you can be treated at a public hospital under Medicare or pay for the fees yourself in a private hospital’s Emergency Department.
If you’re admitted to a private hospital after treatment in an Emergency Department, the fees associated with your admission and further treatment will be covered, so long as the treatment is listed on your policy.