ACCOUNTS

The hospital has a policy of not extending credit to any patient.  All patients will be provided, in advance of their admission, an estimate of the out-of-pocket expenses for their hospitalisation.

All patients, whether insured and self-insured, are personally liable for costs that they may incur as part of their hospitalisation.  (Such costs may include theatre fees; accommodation; intensive care; surgery fees; anaesthetic fees; prosthetic items; surgical appliances; pharmaceuticals; and allied health services such as physiotherapy)

Health Fund Updates

The hospital maintains contracts with the majority of Health Funds. These contracts, and their conditions, are subject to review from time to time.

To ensure that your health fund has a contract with Calvary John James Hospital, please contact our Admissions or Accounts staff on (02) 6281 8100.

Before your admission to Calvary John James Hospital, you are also advised to contact your health fund to ensure you are covered for the services you may require.

While we would like to provide links to all the fund sites, the constantly changing health fund environment makes this difficult. We suggest you use your own fund contact information.

As a health fund member, your needs may change over time. For more information regarding which health fund best suits your needs, go to the Australian Health Insurance Advice (iSelect) web site.

If you are not satisfied with any aspect of your health insurance cover, you can contact the Private Health Insurance Ombudsman, who provides private health insurance members with an independent service for health insurance problems and enquiries.

The Private Health Insurance Ombudsman site also has useful information about what you should expect from your health fund, changing your health fund, and lodging a complaint. The site has a series of brochures available for the general public, which can be ordered on-line, or by calling (02) 9261 5855.

Insured Patients

As a service to patients with an Australian registered health insurance fund, the hospital is prepared to claim directly on the insurance fund for costs incurred, though insured patients must still pay all excesses or co-payments prior to admission.  The admission will not proceed unless these are paid.

To submit the claim we require your private health insurance details and Medicare number prior to admission, and the completion of the necessary claim form on admission.  Please note that the submission of the claim on the patient’s behalf does not constitute settlement of costs incurred.  Should a benefit be reduced or denied by the health fund for any reason, or further charges realised, the patient remains responsible for any unpaid portion of the account.

Where a co-payment is related to length of stay, then the admitting doctor’s estimated length of stay is used.  The balance must be paid on discharge.  In the event of an insured patient’s claim on their health fund being refused, the account must be paid within seven (7) days.

If any debt remains outstanding after seven (7) days, debt recovery proceedings will commence.

Self Insured Patients

This covers patients with no Australian health fund insurance.  All patients will be provided with an estimate of costs.  Self-insured patients should pay this estimate in full five (5) days prior to admission, otherwise admission will be deferred until such time as payment can be made.  The estimate of costs will include all costs in relation to accommodation, theatre fees, prostheses and disposables.  Whilst every attempt is made to ensure an accurate estimate, the final costs of prostheses, disposable items and actual theatre time may vary for a range of reasons.  Accordingly, any difference will either be refunded by the hospital within seven (7) days of the procedure, or will need to be paid by the patient upon discharge.

If any debt remains outstanding after seven (7) days, debt recovery proceedings will commence.

Compensable Patients

Patients whose admission is related to a Third Party, Public Liability, Workers Compensation claim, or claims under criminal injury matters, will be required to provide a letter from their insurance company or employer five (5) days prior to admission, stating that the third party accepts liability for payment of costs incurred with regard to the patient’s hospitalisation and associated treatment.  Failure to provide such a letter will result in the patient being considered a self-insured patient with the conditions of ‘self insured patients’ being applied.

As most insurers/employers will only cover the cost of a Shared Ward, the additional cost for a requested private, en-suite or VIP room must be settled by the patient prior to admission.

Regardless of the undertaking of the insurer or employer, the patient remains personally liable for all costs.  Any costs which remain outstanding after thirty (30) days will be required to be settled by the patient in full within seven (7) days of receipt of the outstanding account.  If any debt remains outstanding after seven (7) days, debt recovery proceedings will commence.

Additional Services

During your admission the doctor may order x-rays, pathology or paramedical (e.g. physiotherapy) services, as well as the services of other doctors.  These services will be billed separately, and may not be wholly covered by Medicare and/or private insurance.  If you have any queries regarding these fees please ask the respective provider.

Some patients admitted to the hospital may need admission to the Intensive Care Unit for treatment.  The cost of these services may not be wholly covered by your private health insurance.  In additional to the bed fee cost, the Intensivist’s fee may not be wholly covered by Medicare.