Going to Hospital Guide

Love a simple hospital guide 

Going to hospital can be a stressful time. We’re here to help!  

We really do care about people (the hint is in our name) and we want you to know we’ve got your back when you need us. We’ve put together a guide for your hospital stay – from what to ask your doctor to how we pay the bills so that you’re fully informed. 

Grab a cuppa and read on. 

Download the Hospital Stays Guide

​Planning your hospital stay

Visit your GP

You might know the drill – you need a referral from your GP to see a specialist doctor (like a surgeon for instance) to kick off the whole planned procedure process. 

Find a specialist

Using our provider search on our website gives you a decent indication of how much each specialist tends to charge under our Access Gap scheme.

Visit your specialist & get an itemised quote

When you visit your specialist, you’ll get to learn about the treatment options your specialist recommends for you. It’s a good time to gather information to help you make a decision about your next step.

Call Peoplecare

A simple phone call could save you time and make you feel confident with your upcoming planned procedure. Plus, we have a team of member advocates whose entire job is to help you with your hospital admission and answer your hospital questions – so why not benefit from their expertise?

Book your procedure & plan your hospital stay

Call your specialist and book in the procedure. An important step at this point is to ask about your recovery plan, as this will help you plan what to do when you leave hospital and how long your stay will be. 

Go to hospital

You will be admitted to the hospital the day before or on the day of your procedure. Your friendly hospital staff will wheel you into theatre when they’re ready. After your procedure, you will be in the recovery ward before being taken back to your room.

Check out of hospital & recover

Before you leave hospital, make sure you take your discharge plan and discharge summary. 

Get help for chronic conditions

People with chronic conditions need a bit of extra help to get on top of their health.

More information

 

  • Discharge Planner 
    A Discharge Planner (also called a Continuing Care Coordinator) manages patient transition from hospital to another health facility or home.
  • Physio/exercise physio 
    Physios & exercise physios specialise in your physical recovery from hospital and help you strengthen your muscles with targeted exercises, movements and hands-on treatment. 
  • Social worker 
    Social workers can help connect you to community services that can assist in your care when you return home. 
  • Nurse Unit Manager 
    A Nurse Unit Manager (who used to be called a Matron) is the head nurse who manages all the nurses. 

 

Peoplecare is the not-for-profit health fund devoted to making going to hospital easy for you. The hint is in the name! 

 Peoplecare is the #1 health fund for: 

  • dealing with members as individuals (did someone saypeople?); 
  • the way we treat our members through our call centre; and the important one for you right now 
  • pre-hospital advice and information about doctor gaps* 

 In short, we’re here for you.  

Want another reason to feel at ease? More than 85% of all in-hospital medical services are gap-free for people using their private hospital cover.^ 

*Ipsos biennial Health Care and Health Insurance Survey 2017 

^Private Health Insurance Medical Gap Statistics December 2018, Australian Prudential Regulation Authority 

 

We like to keep things simple at Peoplecare, but there are still a few things to learn to help you understand how to use your health cover. 

Accommodation 

Accommodation covers a bed and meals in hospital. It also includes in-hospital services like nursing and is separate to your doctors’ bills.

Excess  

An amount you agree to pay per admission when you go to hospital in exchange for a lower premium. Peoplecare lets ‘kids eat free’, meaning that you don’t have to pay an excess to go to hospital for kids under 21 who are covered by a family policy.

Our excesses are halved if it’s a day stay and the full excess for an overnight stay and longer. You only have to pay your full excess once each financial year on single covers and up to double your excess on couple and family covers (e.g. the full excess for two parents on a family cover).

Medical expenses 

Fees for medical services while you’re in hospital. Things like doctor & specialist fees, radiology, pathology and anaesthetists.

Out-of-pocket expenses 

When doctors charge more than the Medicare Benefits Schedule Fee. And by doctors, we’re talking about a range of specialists from surgeons to anaesthetists. Also called out-of-pocket costs. Same thing.  

Pre-existing condition 

A pre-existing condition is any aliment, illness, or condition that you had signs or symptoms of (in the opinion of a medical practitioner appointed by the health insurer) that existed during the 6 months before you joined a hospital cover or upgraded to a higher hospital cover. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn't seen your doctor about it before joining the hospital cover or upgrading to a higher hospital cover. This waiting period only applies to hospital cover, not extras cover.

Pre-existing condition restrictions don’t apply to the following services:  

  • Rehabilitation, hospital psychiatric services, palliative care have a 2-month waiting period
  • Ambulance has a 1-day waiting period

Read more about pre-existing conditions.

Theatre fees 

Costs for procedures performed in an operating room, including day surgery facilities.

Waiting period 

How long you have to hold your cover before you can make a claim. Refer to your Cover Description or call us for more detail.

 

View our entire glossary here.

 

Between Medicare, private health insurance and out-of-pocket expenses, figuring out who pays what can be tricky. Luckily for you, we’ve come up with this handy chart. 

Benefits depend on your level of cover and any restrictions, exclusions or waiting periods you have and the 12-month wait for pre-existing conditions. 

You can check what you’re covered for and your waiting periods using our Online Member Services, or by giving us a buzz on 1800 808 690. 

View your full cover description for more detailed info.

  Medicare Peoplecare You
Hospital Extras
Ambulance
Find out more about ambulance cover
No Yes Yes No
Outside hospital (out-patient)
Things like GP & specialist fees, radiology & pathology
Yes No No Yes
In hospital (in-patient)
Things like doctors' fees (including specialist, radiology & pathology), accommodation & theatre fees while you're in hospital
Yes Yes No Yes
Public hospital charges
If you're admitted as a public patient
Yes No No No
Public hospital charges
If you're admitted as a private patient
Yes Yes No Yes
Private hospital charges
Like accommodation fees, theatre fees & prostheses
No Yes No Yes
Other services
Things like dental, optical & physio
No No Yes Yes

See step 7 for how to claim your hospital stay.