Going to Hospital? Here's what you need to know - Effective 1 August 2021 - Bupa
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Going to Hospital? Here’s what you need to know Effective 1 August 2021
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
What happens when you arrive at hospital? . . . . . . . . . . . . . . . 3
Ambulance services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Who pays for healthcare in Australia? . . . . . . . . . . . . . . . . . . . . . 5
Australia’s healthcare systems . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
About the Public System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
About the private system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Who delivers healthcare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Getting financially ready for your stay . . . . . . . . . . . . . . . . . . . . 8
Preparing Informed Financial Consent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
to go to What’s the Bupa Medical Gap Scheme? . . . . . . . . . . . . . . . . . . . 9
Seeing a specialist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
hospital What is a pre-existing condition? . . . . . . . . . . . . . . . . . . . . . . . . . 11
What you’re covered for. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
If you’re getting ready
Bupa Hospital Covers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
for an admission to
More value from a Bupa membership . . . . . . . . . . . . . . . . . . . . . 14
a hospital, there are
What’s the difference between hospital and medical costs? 15
decisions you should
Things you might not be covered for: . . . . . . . . . . . . . . . . . . . . . 16
consider and choices
to make to get the best Going to hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
outcomes, health and Things to do before admission . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
financial. How to have a better stay. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
After your treatment or surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 19
We’ve put together
Leaving hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
this guide to help you
Will I go straight home? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
understand what to
What do I need to take with me? . . . . . . . . . . . . . . . . . . . . . . . . . 21
expect.
Once you’re home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
How to claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
We’re here to help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2
Introduction Medicare
Medicare may not cover ambulance costs.
Costs for an Ambulance are calculated State you Options to fund
normally Ambulance services Medicare is public access to healthcare
based on a call-out fee plus a per-kilometre (paid by taxpayers) and it covers:
charge from the ambulance base to the live in
What happens when you call-out location, hospital or other facility,
NSW • Pay yourself.
• Treatment as a public patient in a public
and then for it to return to the ambulance hospital
arrive at hospital? base. • Use Private cover
ACT • 75% of the fee on a Government list
When you get to hospital you will be (included in most
When it comes to ambulance services, called the Medicare Benefit Schedule
asked some questions to protect you from Hospital or Extras
each state is different. In some states, an (MBS) for doctors’ services in hospital if
some avoidable problems. Here are some covers).
ambulance may already be covered, or you you’re a private patient
questions you may be asked about: VIC • Pay yourself
can include it in your cover. You should • All (what’s known as ‘bulk billing’) or
• Any allergies consider what you’ve chosen to be covered • Use Private cover some of the cost of going to a GP or
for, the state you live in. NT (included in most specialist
• Current medication
Hospital or Extras • Some (but not all) tests and examinations
• Existing or past health problems The table to the right compares your SA covers). your doctor orders for you
options.
• Recent overseas trips
Country • Get an Ambulance • Reduced cost on some prescription
• Pregnancy or breastfeeding subscription (see our list medications, if they’re on an
It’s worth noting: WA
of recognised providers Australian Government list called the
Once the nurse assesses you, you may • Some States offer free or subsidised listed on page 4). Pharmaceutical Benefits Scheme (PBS)
need to go back into the waiting room if ambulance services to pension and
there are more serious cases ahead of you. concession card holders. Check your Metro WA • Pay yourself.
That said, it’s important to tell them if your state Government website for more Private health insurance
& Norfolk • Use Private cover
condition changes or worsens. details. Island Your health cover with Bupa can include
(included in most
• Some States have agreements with cover for:
When it’s your turn, you’ll be taken to a Hospital or Extras
treatment area to be assessed and treated. other states to cover their residents, covers). • Hospital treatment: Once you’re admitted
If staff can treat you in the emergency and vice versa. This varies, so if you to hospital, private hospital cover will
department, you’ll be able to go home travel interstate frequently, it could be TAS • The Government covers help pay for the costs of treatment and
afterwards. Emergency department worth considering private cover or a you everywhere, except your stay. Medical costs may be reduced
treatment is an outpatient service. If the subscription. for in QLD and SA. using Bupa’s Medical Gap Scheme.
problem is more serious or needs ongoing • Some covers, subscriptions and • If you travel to these • General treatment: Also called ‘Extras’, or
care, you’ll be admitted to hospital and agreements between states only offer States frequently, you ‘Ancillary’ this can include dental, optical
the treatment you receive will be as an cover for Ambulances by road, and not could consider private and physiotherapy treatments.
inpatient. air. It’s worth checking what they’ll cover cover, or you’ll need to
pay these costs yourself. • Ambulance: In some states, an
before making your decision.
ambulance may already be covered, or
Ambulance services QLD • The Government covers you can include it in your cover
The following providers are
If you need an ambulance (via road or air), you everywhere in
recognised by Bupa: Check out mbsonline.gov.au for a list of
it’s important to know what your options Australia.
• ACT Ambulance Service services subsidised by the Government.
are to pay for it. Each has a fee that the Government says is
Policy and Fund Rules apply. See your policy information
• Ambulance Service of NSW appropriate to charge for that service.
for further details.
• Ambulance Victoria
Your doctor or specialist can choose to
• Queensland Ambulance Service Who pays for healthcare in charge more than this fee, which may lead
• South Australia Ambulance Service Australia? to a remaining amount to pay.
• St John Ambulance Service NT
Depending on how you use the healthcare
• St John Ambulance Service WA system, funding either comes from the
• Tasmanian Ambulance Service Government, private health insurers, and
sometimes – you.
4 5
About the Public System Who delivers healthcare?
Australia’s This includes public hospitals, community-
based services, and health organisations
largely owned and governed by state and
General Practitioner (GP)
Your GP is usually your starting point for
healthcare systems
health care. They’ll assess any problems
territory Governments. and try to treat your immediate health
Public hospitals in Australia provide high concerns. They can also arrange for tests
quality medical care at low (or no) cost to to help with their diagnosis e.g. blood
Medicare card holders. They’re Government samples, and refer you to a specialist,
funded, and taxpayers pay an additional hospital or allied health professional.
The healthcare world can feel a bit complex. In this guide,
we’ll help break it down so you can understand how it works. Medicare levy to support the public health Specialists
care system.
In Australia, we have public and private health care systems. A medical specialist is a doctor who has
Depending on what you’re getting treatment for, health If you need elective surgery (non-urgent a high level of education and training
professionals like doctors and specialists can treat you in either. treatment) and choose to be a public in a specific area of medicine – like a
patient, you may need to wait longer for cardiologist, who specialises in treating
surgery. You also won’t be able to choose heart conditions.
your doctor, much of your care may be
delivered by doctors-in-training and you
Allied health professionals
may need to share a room as you recover. Allied health providers are qualified
health professionals who are focused on
How do I use my Bupa cover in a preventing, diagnosing and treating a
Public Hospital? range of conditions. This includes people
like psychologists, occupational therapists,
When you’re admitted, you’ll probably be radiographers, pharmacists and podiatrists.
asked if you have private health cover. It’s
entirely up to you whether you want to
be treated as a public patient or a private
How do I use my Bupa cover
patient – a choice protected under the in a Private Hospital?
National Health Reform Agreement. Private hospitals provide high quality
medical care for patients and offer an
If you choose to use your Bupa cover
extensive range of health care services.
in a public hospital, you should ask the
These hospitals are owned and operated
following questions
by private organisations and licensed and
• What are the benefits if I use my private regulated by the Government.
health insurance?
Typically, you’ll have more choice as a
• Will my care be any different if I choose private patient - like choosing your doctor,
private? shorter wait times for elective or planned
• Can I choose my doctor? surgery, and the choice of a private room (if
• Can I get a private room? available and clinically appropriate).
• What extra fees / charges (if any) will I In a Private Hospital Bupa are able to
need to pay? cover you for*?
• A private room
About the Private System • Theatre and accommodation fees
The private system is made up of health • Inpatient Pharmaceutical Benefits
providers that are owned and operated Scheme (PBS) drugs
or deliver services privately, like private • Inpatient allied health services
hospitals, medical and allied health • Listed prosthesis
professionals and pharmacies.
• Access to the Bupa Medical Gap Scheme
*Covered by your policy. 7
Talk to your specialist Informed Financial Consent
Your specialist or treating doctor(s) have
Before you receive any treatment you are
to give you the cost of any out-of-pocket
entitled to ask your doctor, your health
expenses and get your agreement before
insurer, and your hospital about how much
your admission. Ask them whether they
your treatment will cost, including any
participate in the Bupa Medical Gap
extra money you may have to pay out of
Scheme and will agree to use it for your
your own pocket, commonly known as a
treatment, how long you’ll be staying in
‘gap’ payment. Informed financial consent
Hospital, and whether there are additional
must be confirmed in writing so it’s clear
costs (like prothesis, for example). All costs
that you have received and understood this
should be discussed with you prior to being
information and agreed to it.
admitted to Hospital. Refer to page 10 for
more information. The clinical consent form (for your consent
to the procedure itself) comes with the
Ask for the Medicare Benefits Schedule
Getting
hospital’s Admission Information pack.
(MBS) item number(s) they’ll be using, so
we can confirm you are covered for that In your hospitals Admission Information
procedure and make sure you receive any pack, you’ll have to fill out the Clinical
out-of-pocket costs for anaesthetists, consent form. It’ll mean you’ve been given
financially
assistant surgeons, pathology and accurate information that you clearly
radiology. understand and that you agree to the
procedure itself.
Talk to Bupa
ready for Call us before you book in your admission Make sure you:
with the MBS items numbers to make sure • Understand what treatment or surgery
you are covered for your service (also see you are having, and why you are having it.
your stay
the ‘what you’re covered for’ section). We
• Understand all your options, including
can also talk you through waiting periods,
what happens if you don’t have the
restrictions or exclusions, excess or co-
procedure.
payments or whether your hospital is a
Members First or Network hospital. • Ask any questions you have so that
you understand the risks and potential
There are a few things you can You may have lower (or no) out-of-pocket complications and what will be done to
do to ease your mind before medical costs if your treating doctor(s) prevent these.
going into hospital. elect to use Bupa’s Medical Gap Scheme –
• Know you can withdraw your clinical
we’re happy to talk you through this (check
informed consent at any time during your
out the next page for more).
hospital stay. This can be done verbally,
or in writing. If its withdrawn during a
Talk to your hospital course of treatment, the treatment must
Before you’re admitted, the hospital staff stop.
will check your membership eligibility and
let you know if there are any out-of-pocket
expenses such as excess or co-payment.
They’ll get your consent in writing (which
is mandatory), by asking you to sign an
Informed Financial Consent (IFC) form
before or on admission with an information
pack.
9
What’s the Bupa Medical What can I expect if my doctor/s Who pays? To confirm if your proposed treatment might
be related to a pre-existing condition, or if your
use the Bupa Medical Gap Scheme:
Gap Scheme? If you’re eligible for Medicare and have a referral,
treatment is eligible for benefits to be paid, we’ll
In a Public Hospital: Medicare will reimburse you for a portion of your
ask you to provide documentation, such as:
The Bupa Medical Gap Scheme is all about specialist consultations and treatments. Without
reducing the medical costs you need to • If you have a pre-booked admission, you a referral, you’ll need to pay the specialist • Bupa medical certificates signed by your
pay for treatment when you’re admitted to may be charged up to a limit of $500 for consultations and treatments in full yourself. general practitioner (GP) and any specialists
hospital. If your specialist uses our scheme, your treatment by that doctor while you are you consulted.
you’ll never pay more than $500 per doctor. in that hospital. Depending on your level of cover, Bupa will
cover the specialist costs if you’re admitted to • Referral letters from your GP to specialist/s.
Each doctor involved in your treatment can • If you’re admitted any other way (e.g.
choose to use the Bupa Medical Gap Scheme through the Emergency Department), your Hospital, but no health insurer in Australia can
and if necessary and appropriate
for your admission in a Public Hospital, or doctor will bill Bupa directly and you’ll pay cover specialist costs when out of Hospital, as
a Private Hospital with which Bupa has an nothing while you’re in that hospital. set out in the Health Insurance Act 1973. • Emergency department notes if you were
agreement. treated through a hospital emergency
In a Private Hospital with which Bupa has Things to find out before seeing department.
The ‘gap’ is the amount you’ll need to pay an agreement: • Doctors’ notes from your medical
a specialist:
yourself if your doctor or specialist charges appointments.
more than what Bupa and Medicare will • You’ll never have to pay more than $500 • The name of the doctor you’d like to see
for medical treatment per doctor – we may • For injuries resulting from accidents, we will
pay (Health funds pay 25% of this fee, and • What your options are in public vs. private
even pay for the full cost while you’re in that also need a medical certificate or report from
Medicare pays 75%). Bupa provides two • A referral from a GP or another specialist (if
hospital. Any excess or the licensed practitioner you saw in the 72
different arrangements — either ‘no gap’ or a you don’t have one, it can be more expensive)
co-payment will still apply based on hours following the accident.
‘known gap’.
your level of cover. Find out more at: • An understanding of fees and waitlist
As required in the legislation and to ensure a
bupa.com.au/medicalgapscheme
No Gap proper assessment in relation to your claim,
If your specialist is registered with the Bupa While you’re there, it’s worth Bupa will appoint a doctor to assess the
Medical Gap Scheme with no gap, they’ll Seeing a specialist asking about: information and determine whether, in their
bill Bupa directly and you won’t have to • Options for treatment opinion, and consistent with normal medical
Your GP or specialist will provide you with a practice, they are satisfied that there would
pay anything for your specialist’s services in • Referrals for second opinions if necessary
referral if your condition needs specialist care have been signs or symptoms of the condition,
hospital. You may have to see multiple doctors
that your referring doctor can’t provide. The • Any follow up appointments ailment or illness in the period before you
for one procedure.
treatment options you and your doctor would joined, even if you had not yet had a diagnosed
like to explore may influence which and what condition or seen a doctor. If the signs or
Known Gap
type of specialist you choose. What is a pre-existing symptoms would have been evident, then this
If your specialist is registered with the Bupa
Medical Gap Scheme with a known gap, You don’t need a referral to see a specialist
condition? is considered a pre-existing condition under the
Private Health Insurance Act (2007).
they’re able to charge you a gap up to a but not having one may mean extra costs and A pre-existing condition is any condition, ailment
maximum of $500 for services provided in some details missing about your health that or illness, of which you had signs or symptoms The outcome is decided by the doctor appointed
hospital. normally will come from a referring doctor. during the six months up to the commencement by Bupa, and not your treating doctor, but any
of your cover, or when you upgraded to a higher information provided by your doctors will be
Chat to your specialist about this before you level of cover with us.
book your first appointment. They can refer
Specialist fees considered.
to the Bupa Medical Gap Scheme and let you Specialist fees can vary from doctor to doctor There is a legislated 12-month waiting period
know what gap arrangement they’ll make. and may not be easy to determine until you before benefits are payable for pre-existing What are signs and symptoms?
Remember, you may have to see multiple have that initial consultation with your medical conditions for most hospital cover products. A symptom of a condition is what you
doctors for one procedure. specialist. For some products for overseas visitors, there is experience, while signs are evidence of the
lifetime ineligibility for hospital treatment related condition that your doctor could have found
The hidden waitlist to a pre-existing condition. through examination.
Your specialist can choose whether or
not to use the Bupa Medical Gap Scheme A specialist referral is often made without any A doctor may find signs of a condition even if
for your treatment. We recommend you idea of how long you are going to have to you have no symptoms and you haven’t noticed
confirm with them directly if they’ll use wait, especially if your condition is not urgent. anything wrong. If this is the case, you may have
the Scheme for your treatment, and to a pre-existing condition without realising it. A
check what costs they may charge, so diagnosis doesn’t need to have been made for a
you know what out-of-pocket costs you condition to be pre-existing.
may have to pay.
10 11
More value
from a Bupa
membership
Members First Hospitals
Travel and
accommodation benefit
Network Hospitals
Accident Inclusion
Ultimate gap bonus
13
Bupa Hospital Covers More value from a Bupa
All of Bupa’s private hospital covers are membership
classified by the Australian Government When you use our national network of
tiers of gold, silver, bronze and basic. hospitals, you can access a range of
These all include the use of standard benefits.
clinical definitions or categories, with the
aim to make inclusions and exclusions for
Members First Hospitals
treatments easier to identify.
If you go to a Members First hospital, in
The Australian Government published most instances, you’ll be covered for your
the table on page 16 to display minimum hospital expenses - like accommodation,
requirements of standard clinical categories operating theatre, and intensive care fees
to be offered within each tier for hospital (if applicable).
What
treatment products. Where Bupa has
chosen to provide more than the minimum At Members First day hospitals there
requirements as set by the Australian are also no out-of-pocket expenses for
Government you will see a “Plus” in the title inpatient medical services (e.g. your
specialist’s fees).*
you’re
of the hospital product.
For Overseas Visitors Hospital Covers, You’ll also have the added benefit of a
Working and Non-Working products, there private room or $50 back (paid by the
may be slight variations to some of the hospital) for overnight admissions except
covered
standard clinical definitions or categories. for particular circumstances, for example if:
Additional categories may also apply. The • Your hospital visit isn’t booked at least 24
four tiers do not apply to these covers. hours before admission.
for
What does optional cover mean? A health • You become a nursing home-type patient
insurer may choose to offer this on a (i.e. you stay in hospital more than 35
restricted or unrestricted level of coverage. days without an Acute Care Certificate).
What is restricted cover? If you have • You’re admitted via an Accident and
restricted cover for a treatment, it means Emergency Department.
Private health insurance can you’ll be covered most of the time for a • You are a day patient (including if your
contribute to your hospital shared room in a public hospital, but that stay leads to an unplanned overnight
and medical costs – but it’s you may face large out-of-pocket costs stay).
for a private room if you stay in a private
important to know what • Where it’s clinically inappropriate.
hospital.
you’re actually covered for. • You don’t request a private room at time
If you’re on an Overseas Visitors cover, of booking.
it means you’ll have large out-of-pocket
expenses if admitted to any hospital for a You’ll also have access to other benefits
restricted cover service. such as a daily newspaper, local phone calls
and Free to Air TV at no additional cost.
Please refer to each individual product
*Not available in NT, any excess or co-payment related to
to see if Bupa has included the clinical
your cover will still apply.
category within a “Plus” product.
14 15
Clinical categories Gold Silver Bronze Basic
Travel and accommodation benefit What’s the difference
If you need to travel 200km or more to between hospital and
Rehabilitation R R get essential treatment, we can help cover medical costs?
Hospital psychiatric services R R R some of your travel and accommodation
Palliative care R R R costs. The benefit is per person, per trip When you’re admitted to hospital, the
(limits apply), can be used as many times services you receive are separated into two
Brain and nervous system
as needed throughout the year and only different categories — hospital and medical.
Eye (not cataracts) They’re charged differently so it’s worth
applies to hospital cover. See your policy
Ear, nose and throat information for more details. knowing what to expect.
Tonsils, adenoids and grommets
Hospital costs can include:
Bone, joint and muscle Network Hospitals
• Accommodation for overnight or same-
Joint reconstructions If you go to a Network hospital and you
day stays.
Kidney and bladder have the right level of cover, in most
Male reproductive system instances you’ll be covered for hospital • Operating theatre and intensive care fees
expenses like accommodation, theatre, and (as applicable).
Digestive system
intensive care fees. At a Network hospital, • Any medicines approved by the
Hernia and appendix
you’ll also have access to local phone calls, Pharmaceutical Benefits Scheme (PBS)
Gastrointestinal endoscopy where available, pay TV and Free to Air you’re prescribed as part of your in-
Gynaecology TV at no additional cost. That said, a small hospital treatment.
Miscarriage and termination of pregnancy number of Network Hospitals may charge a
• Physiotherapy and other allied health
daily fixed fee.
Chemotherapy, radiotherapy and immunotherapy for cancer services, including occupational therapy
Pain management and dietetics.
Accident Inclusion
Skin • Surgically implanted prostheses up to the
Breast surgery (medically necessary)
If your cover includes the Accident approved benefit in the Government’s
Inclusion feature and you’re involved in an Prostheses List. It’s best to check costs
Diabetes management (excluding insulin pumps)
accident (in Australia) after joining, hospital with your specialist before going into
Heart and vascular system treatments that are restricted or excluded hospital.
Lung and chest on your cover will be payable in the same
way as an included service. Treatment
Blood
Medical costs can include:
Back, neck and spine
needs to be given within 72 hours of
the accident, and any further treatment • Fees charged by specialists involved in
Plastic and reconstructive surgery (medically necessary) your hospital treatment (e.g. surgeon,
for that accident where an admission or
Dental surgery
readmission is required must be within 180 anaesthetist).
Podiatric surgery (provided by a registered podiatric days of the event. • Pathology and radiology diagnostic tests
surgeon)*
recognised by Medicare, performed in
Implantation of hearing devices
Ultimate gap bonus hospital by Bupa recognised providers.
Cataracts
This is only available on Gold Ultimate – Any out-of-pocket costs above the
Joint replacements Health Cover and Ultimate Corporate MBS fee
Dialysis for chronic kidney failure Health Cover - Gold. Receive a $200 bonus
Pregnancy and birth when you join Bupa and every calendar
Assisted reproductive services
year thereafter. This can be used towards
a doctor or specialist’s out-of-pocket costs
Weight loss surgery
(while in hospital) and any unused bonus
Insulin pumps
amounts will accumulate each year.
Pain management with device
Sleep studies
Key: R = Restricted · *Limited hospital accommodation and approved prostheses benefits
16 17
Things you might not be Excess and co-payments When you leave hospital
covered for: Depending on your level of cover, you may You may need to pay for services or
need to pay an excess and/or co-payment products when you’re discharged from
If you have exclusions or restricted for your hospital admission. Check with hospital. Depending on your cover and the
cover Bupa or the hospital to see what excess hospital you go to, these can include:
and/or co-payment (if any) will apply to
Sometimes specific services or treatments • Pharmacy items not opened at the point
your hospital stay.
may be excluded under your level of cover. of leaving hospital or provided to you
This means you’ll be responsible for all upon discharge (though a benefit may
expenses related to your hospital admission Fixed fees be payable by Bupa depending upon the
for that procedure or service. This is a daily charge billed by a small item and your level of cover).
If you only have ‘restricted cover’ for a number of Members First and Network
• Fees for things like movies and non-local
service, the amount we can pay for your hospitals that you’re responsible for paying.
phone calls.
hospital accommodation is the minimum The hospital should tell you about any
fee when you make a booking. Fixed fees • Provider or patient requested non-
shared room benefit set by the Australian
allow Bupa to bring you a greater range of emergency ambulance transportation.
Government. It means you’ll likely be
covered in a public hospital, but if you hospitals that offer certainty around costs.
choose to go private, you’ll have large out- If you have Gold Ultimate Health Cover, If you receive benefits from another
of-pocket expenses. you’re reimbursed for any fixed fee. source
If you’re on an Overseas Visitors cover Your health insurance doesn’t apply where
and if you only have ‘restricted cover’ for Ambulance service compensation, damages or benefits may be
a service, we’ll pay a benefit equalling the Bupa covers emergency ambulance claimed from another source in relation to
Australian resident public hospital minimum transport and on-the-spot treatment in a condition, injury, or ailment (e.g. workers’
shared room benefit set by the Australian most cases in your state – unless you compensation).
Government. It means the benefit will can claim it from another source (like
not fully cover the cost for your hospital compensation or through a private As a nursing home type patient
accommodation, and you’ll have large out- ambulance subscription). Usually this is If you’re assessed during your hospital
of-pocket expenses. capped at one service per calendar year for stay as no longer needing acute care and
single memberships and two for family and in hospital for more than 35 days, you’ll be
If a treatment or service is excluded single parent memberships.
or restricted on your cover classed as a nursing home type patient.
If this happens, Bupa will pay benefits
Contact Bupa as there will be significant If it’s not an emergency, your transport isn’t
that are much lower than normal hospital
out-of-pocket costs, even when you have covered. That includes things like transport
benefits and you’ll need to make a personal
‘restricted cover’. This can mean a 12-month to or from hospital to home, a nursing
contribution towards the cost of your care.
pre-existing condition waiting period if you home or another hospital for ongoing
upgrade your cover to be eligible for those treatment.
services. You can purchase Premium Ambulance
What happens when one treatment Cover on its own, or in addition to your
is covered and the other is excluded existing hospital cover. Call us on 134 135
under my private hospital cover? for more information.
If you’re admitted to hospital for multiple
treatments and one or more of those
treatments isn’t covered on your policy,
Bupa will pay a benefit towards the
included treatment (if you have served any
applicable waiting periods), but not the
excluded treatments. You’ll be responsible
for all expenses related to the treatment
which is excluded on your policy.
18Going to
Things to do before How to have a better stay
admission
Know your rights and responsibilities
Apart from contacting us before your
hospital
As a patient, you have rights during your
admission, requesting a private room, and
hospital stay. For example, you’re always
doing all the necessary paperwork, there
entitled to know the identity and role of
are a few things to think about before you
the hospital staff who are caring for you.
go in for your stay.
When coming into your room, they should
introduce themselves and tell you why
Pack well they’re there. If not, you can ask.
Things to consider include:
You have the right to ask questions to
• Comfortable clothes, sleepwear, help you understand your treatment, any
underwear and toiletries tests you have, and how your recovery is
• Medication in its original packaging progressing. In turn, it’s your responsibility
to give accurate and complete information
• Leave jewellery at home where you can.
to your treatment team – and speak up if
It will be taped over if it’s hard to remove,
anything isn’t clear.
but if there’s an emergency your jewellery
may need to be cut off
Have your individual needs met
• Don’t apply any make up or nail polish
before your procedure For any personal requirements, make sure
you tell staff about:
• Not taking valuables (but bring a small
amount of cash or a credit card in case) • Any special dietary requirements (e.g. if
• Bring something to do if you’re staying a you’re vegetarian, have diabetes, or need
while – a good book or some magazines gluten-free, halal, or kosher foods)
always help. • If you need an interpreter
• Any religious or cultural requirements
Follow pre-operative instructions • Other special needs (e.g. if you have
Remember that any instructions about reduced mobility, or vision or hearing
what to do to prepare for your operation impairment)
are for your safety. That includes bathing,
fasting, etc.
Make sure medicine is ready to go
Confirm your list of medicines (prescription
and non-prescription) and any details the
staff need to know (like dosage, what it’s
treating, etc). It’s really important that you
give medicine to staff when you’re being
admitted and tell them about any allergies
or reactions you’ve had to medication.
21After your treatment or Pain relief Preventing infection Preventing falls
surgery If you need pain relief it can be given to you Depending on the procedure you have To help reduce the chance of falls while you
in the following ways: had, you may be given antibiotics to help are in hospital (and when you get home),
prevent infection. Your doctor will decide make sure you:
Waking up • By patient-controlled analgesia (PCA): if you need to continue to take antibiotics
After your procedure, especially if you have this is a device that allows you to control • Take your time when you are getting up.
after you are discharged.
had an anaesthetic, you’ll be in the recovery your own pain relief. When you feel pain,
• Take extra care if you feel unsteady on
room. If you’ve had surgery, you will have a you can push a button that delivers a Always make sure you:
your feet.
bandage or dressing over the site that was dose of medication through an IV line into
• Follow instructions from your doctor • Ask for help if you feel dizzy, light-
operated on. Your pulse, blood pressure, your body. The machine is programmed
and/or nurses on how to look after your headed, or unwell.
and breathing will be monitored for a few so you can’t give yourself too much.
wound.
hours to make sure they are stable, until you Once you’re eating through your mouth • Get to know the ward and your
can be moved to your ward. you can be switched over to getting pain • Wash your hands with soap and surroundings and keep important things
relief medicines orally. warm water and dry them thoroughly, within reach, including your nurse call
You may also still have an intravenous particularly after using the bathroom, and
• By epidural: pain relief medication is button.
line (IV) for fluids, an epidural line (if you ask family and visitors to wash theirs.
given through a tube placed in the space • Ask for help if you need it when getting
have one), drains from the wound, a urine
around the spinal cord, known as the • Make use of the alcohol-based hand to the bathroom or toilet.
catheter, and your dressings if appropriate.
epidural space. This may remain in place rubs which are conveniently located
• At night, turn on the light before you get
You may have a sore throat if you’ve had until you can be switched over to oral throughout most hospitals.
out of bed, and when you’re in the toilet.
a general anaesthetic. You may also need pain relief medication. Make sure you tell
pain relief to help with any discomfort after the nurse if you feel any numbness or Getting up and moving • Use a walking aid (if a physiotherapist
the procedure as the anaesthetic wears off, tingling in your arms or mouth. has given you one), and handrails in
It’s important that you’re able to move
as well as medicines to help manage any the bathroom and hallways. Don’t use
• By mouth (orally): once you’re eating around safely in hospital (e.g. getting in and
nausea and vomiting. unstable items like your IV pole or tray
and drinking well, you’ll get pain relief out of your bed or a chair and going up and
table for support.
medication to take by mouth if required. down stairs).
Preventing blood clots • Wear your glasses and/or hearing aids if
If you continue to be in pain even with If you need physiotherapy, (like after you need them.
Some surgeries mean you’ll need medication, tell your doctor or nurses. hip or knee replacement surgery), a
medication after to prevent blood clots (like • Beware of trip hazards (e.g. anything on
physiotherapist will usually visit you each
hip and knee replacement surgery). the floor such as mats, papers, spills or
day after your surgery to take you through
even your own clothing if it is too long or
Many surgical procedures increase the risk exercises that are designed to help your
loose)
of blood clots forming, particularly in the recovery.
legs. These can break off and travel into the If you are at risk of falls, you may be given a
Soon after surgery, you may be able to sit
lungs which can cause a blockage known as pair of grip socks to wear.
on the edge of the bed, stand, and even
a pulmonary embolism.
walk with help. You’ll need to use walking
Medicines to help prevent blood clots aids until your doctor or physiotherapist
(called anticoagulants) can be given as an says you’re ready to walk unassisted.
injection under the skin or as a tablet. You
An occupational therapist may come
may also be given compression stockings or
around a few days after your procedure
a device that squeezes the muscles of the
to see how well you can take care of your
legs intermittently (intermittent pneumatic
personal hygiene, as well as how well you
compression).
can get dressed.
You may need to take an anticlotting
medicine for a month or so after some
types of surgery. Talk to your doctor if you
have any questions about this.
22 23Will I go straight home? Once you’re home
Sometimes you’ll need further treatment It’s important to look after yourself after a
after a procedure, especially if you have any hospital stay. Here are a few things you can
physical problems or need some extra care. do to make things go smoothly.
Your doctor will be able to give you an idea
of any rehabilitation or extra care you might Medicines
need after, otherwise you’ll be able to go Take your medicines as directed and
home once you’re discharged. contact your doctor if you have any
problems. Your family and friends can get
As a Bupa member, rehabilitation at home your medicines from the chemist if you
may also be an option for you (if you need can’t get there. Dosing aids can be useful
it and have a referral from your doctor or to help you keep track and a medicines
hospital). Just give us a call on 134 135. list or app like MedAdvisor can help you
keep your info together. Ask your doctor or
What do I need to take with pharmacist if you need a hand.
me?
Exercises
Make sure you’ve got: Get your physio to write down any exercises
• The paperwork you need for discharge you need to do – and how to do them
(e.g. a ‘discharge summary’). safely.
• Any letters or information for your GP —
though sometimes doctors/specialists will Preventing falls
send them separately. Take extra precautions at home to reduce
• Your prescriptions and medication— or your risk of falling as you’re moving around.
a list so you can get them from your GP
and pharmacist. You’ll also need written Nutrition
instructions on taking your medication. Good nutrition is important for recovery,
Call us on 134 135 to check the details of so aim for balanced meals. Ask for help
your level of pharmacy cover. preparing meals and shopping if you
• Written instructions for any exercises you need it.
need to do (if applicable).
• Written instructions for looking after your Sleep
wound (if you have one). If you’re having trouble getting to sleep,
Leaving
which can happen after a hospital stay, it’s
Things to make sure you understand worth chatting to your doctor.
before leaving hospital
• Whether you need and can get any
hospital
services to help you at home — a social
worker, occupational therapist, nurse, or
discharge planner/case manager can help
you access any services you may need.
• When you will have a follow up
appointment with your specialist.
• When to call the doctor e.g. if there are
any complications.
25How to claim To make the claims process as smooth as possible, here are a few things to consider. Your hospital costs All Members First and Network hospitals will ask you to complete claim forms on admission, which they’ll send to Bupa on your behalf. The hospital would have asked you to pay any excess, co-payment, or fixed fee upon your admission. Your hospital’s Admission Information booklet also states that, in the event that you need extra services and the cost isn’t covered by Bupa, the hospital will create an account which you’ll need to pay when you’re discharged. Your medical costs If your specialist doesn’t use Bupa’s Medical Gap Scheme, you’ll need to fill out a Medicare ‘two-way claim form’ for all your medical costs. The form is available online at medicare.com.au or in any Bupa store. Medicare will process your claim and pay you the benefit and work with Bupa to pay part of the bill. If you can’t visit a Medicare office during your recovery, contact either Bupa or Medicare and ask for the forms to be sent to you. Statement of Benefits After your hospital and medical claims (from doctors and specialists) have been processed, Bupa will send you statements showing what has been paid on your behalf. Please check that these details are correct and contact us straight away if you have any questions. Your medical statement may include costs charged by specialists you may not have seen directly, like pathologists. Medicare and Pharmaceutical Benefits Scheme (PBS) Safety Nets The Government’s Medicare Safety Net provides financial assistance to people with high out-of-pocket costs for outpatient services that pay a Medicare benefit. Once you reach a threshold, you may be eligible for additional Medicare benefits for the rest of the calendar year. The PBS Safety Net is also available to those who need a lot of medicines on the PBS each year. For more information, visit humanservices.gov.au 26
We’re here to help There’s a lot of info to take in when you’ve got a hospital stay planned, but we’re here to help answer your questions and make sure you’ve got the right cover. Give us a call us on 134 135, visit bupa.com.au or head into a Bupa Health Insurance store. Bupa HI Pty Ltd ABN 81 000 057 590 Effective 1 August 2021 11884-08-21
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