4 questions to ask before you go to hospital

4 questions to ask before you go to hospital

If you’ve got hospital cover and you’re going in for treatment, it pays to be prepared before you go. Here are some good questions to ask.


1. Is my hospital an ‘ahm partner’ hospital?

This is important, because a ‘partner hospital’ is a hospital where we have an agreement in place about the theatre and accommodation charges for services included under your cover. The agreement is to help minimise out-of-pocket costs for your included hospital services (or day surgery procedures). The good news is we have agreements with most private hospitals and day surgeries in Australia.

Keep in mind, if you receive the treatment at a ‘non-partner’ hospital, you’re likely to be significantly out-of-pocket.

Use Find a provider to search for a partner hospital or day surgery.

2. Which hospital treatments will ahm cover me for?

If you have hospital cover, the first place to look is in the product guide. This will show you what’s in, what’s out, and what’s partially covered. If you need more help, just give us a call.

3. Does my doctor participate in GapCover?

OK, it gets a bit complicated here but we’ll explain why this question is important. When you get treated privately in a hospital, Medicare pays 75% of the fees as listed in the Medicare Benefits Schedule and we pay the remaining 25% (as long that service is included in your cover). However, sometimes a doctor charges more than the fee in the MBS, and this is called the ‘medical gap’. The good news is many doctors participate in GapCover, which is our initiative to help reduce or sometimes remove this gap.

Before you go to hospital it pays to find out if there will be other specialists involved in your treatment (e.g. an assistant surgeon or anaesthetist). If so, ask if they will participate in GapCover. Find out more about GapCover.

Use Find a provider to search for a doctor who has registered to participate in GapCover.

4. What are the total costs involved?

It’s important to ask your doctor or specialist for an estimate of medical fees prior to your hospital treatment so that you’re fully aware of what the charges are. Don’t be nervous about asking, it’s your right to know! Try to get the costs in writing, then get in touch with us and we can talk you through what the total costs will be and tell you if there are going to be any out-of-pocket costs.


Want even more info?

Check out our helpful guide with all you need to know about choosing a hospital, making a claim, other questions to ask your specialist and more. View the Going to hospital guide