Public VS Private – when to use your private health cover.

There’s been a lot of media coverage on the cost implications associated with health fund members using their private cover when admitted to a public hospital. So what can YOU do if you’re admitted to emergency and encounter pressure from hospital staff to hand over your HIF details?

Here’s a personal account from HIF member, Nikki, who experienced just that.

In early September 2019, I was forced to take a couple of weeks off work after my appendix decided it was time to break free. From having stomach pain to seeing my GP to being admitted to emergency and undergoing surgery, things escalated quickly. I spent two nights in a WA public hospital and received excellent care all round. Best of all, everything was covered by the public health system which, as you know, is funded by the Medicare Levy - a compulsory 2% tax that all Australian residents pay each year.  

Here's where things got interesting though. Upon arrival at the ED, I was given an admission form to complete which included the option to provide my private hospital insurance info. But having worked at HIF for almost a decade, I was well aware that there are actually minimal benefits to our Members for using their private health cover in a public hospital. Sometimes, it can even lead to unnecessary out-of-pocket expenses, because you might be charged your hospital excess for a private admission – a cost you wouldn’t incur for a public admission. Most importantly, private admissions in a public hospital cost all health insurers a LOT of money – which in turn contributes towards higher premium increases in years to come. 

For example - because I chose to be admitted as a public patient last month, my entire stay cost me nothing. Had I opted to be admitted as a private patient though, HIF would have incurred a bill for around five thousand dollars (addressing everything from my scans to my surgeon, anaesthetist, accommodation and take-home dressings). Plus, I may have been required to pay my $400 excess too!

For curiosity’s sake though, I did ask a nurse what other benefits I’d receive if I handed over my health cover details. I queried if I could choose my own surgeon, and also move from a shared room to a private room. On both counts I was told no, as all the private rooms were full and the surgeons were allocated by the hospital. The only tangible benefit she could offer was free TV access which would otherwise cost $9 a day. I had Netflix on my iPad though so I was happy to waive my TV rights on the basis I’d be saving HIF thousands of dollars in the process. And on my second night there, I was moved to a private room anyway.

In contrast, opting to provide private health info upon admission offers BIG benefits to the hospital itself. Essentially, by billing the health insurer instead of Medicare, hospitals can acquire extra funding. It’s basically double-dipping - and because it’s entirely legal, the hospital staff actively pushed me on numerous occasions to provide my HIF details, even though I politely declined each time. After all, that’s what we pay the Medicare Levy for.

So remember – private hospital cover is absolutely a must-have for elective surgeries and other pre-planned admissions and treatments, not to mention being able to choose your own hospital, specialist and skip public waiting lists too. But for emergency department admissions, public is the way to go - because in the long run, your decision will help HIF keep a tight lid on premium increases moving forward. And as a not-for-profit health fund, the less HIF is required to spend covering public hospital admissions, the more it can contribute towards benefit improvements and other value-adds for Members.

Key things to remember if you’re taken to emergency

  • Don’t hand over your HIF details upon admission unless the hospital can guarantee you enough benefits to make it worthwhile. You may be told that you’ll get things like pyjamas, a towel and a dental pack if you do, but you’ll almost certainly receive those regardless (I did). 
  • When you’re admitted to emergency, you’re likely to be feeling dreadful. That means when filling out the admission form, you may just work your way through the questions as quickly as possible to get that bit over and done with. This is what the hospitals want you to do, and why the ‘Do you have health insurance?’ question is on that form in the first place. So if you can, leave it blank for starters. You can always choose to update your details at a later stage if you really feel it’s worth using (for example, you’re allowed to choose your own surgeon or you can move to a private hospital for further treatment).
  • Once you’re recovering, please get in touch with HIF and share your story as this feedback is invaluable to us.