Anyone Attended a Private Emergency Department Using Their Health Insurance?

I'm wondering what the out of pocket costs others experienced by attending an emergency department at a private hospital using their health insurance.

I understand there are different levels of cover. I'm more interested in what is not covered irrespective of the level.

From what I understand, you pay for everything up to being admitted to the hospital. I'm guessing this may include bloods and scans which could add up.

Other questions I pondered, such as, did you find:

  • more specialists were available? Or like public, many are on-call
  • use of MRI machines in the emergency department? Commonly, public MRI use is limited and for most purposes CT is the mode of choice anyway. But in some cases, MRI is superior and can be used, but not used in public due to cost and the requirement of a specialist to refer.
  • waiting times long?

Comments

  • I haven't experienced that, but wouldn't it be aligned to all the variables such as the level of cover provided by your private insurer, the nature of the treatment, the hospital you went to, etc.

    • Thanks. Updated

  • +2

    When I went I had to pay a fee to see the doctor initially then once admitted the private health kicks in so there may be an excess involved.

    I had to pay for all bloods / xrays seperately although I think the blood tests were bulk billed.

    • I would have thought X-rays would be bulked we well but I guess depends on the scan.

  • +2

    Ring the hospital - they will tell you the exact fees.

    Or try their website.

    Exhibit A…

    Epworth Richmond - Emergency Department fees

    Epworth Richmond charges a flat fee of $400 per patient. This out-of-pocket fee is not claimable under Medicare or private health insurance.

    Depending on your treatment, you may also incur pathology or radiology costs which are on top of the out-of-pocket fee. If you hold a Medicare card, a portion of these will be claimable under Medicare.

    Exhibit B…

    Attending the Hollywood Private Hospital Emergency Department incurs a $200 doctor consultation fee upfront, which is non-refundable and not covered by Medicare or Private Health Insurance.

    This fee will be payable upon presentation and payment by EFTPOS or credit card is accepted.

    Dependant on clinical need, fees for services such as radiology (e.g. X-rays), pathology (e.g. blood tests) and walking aids (e.g. crutches), may incur additional out-of-pocket costs.

    Please note:

    Department of Veterans’ Affairs will cover the Emergency Department fees if you are a gold card holder. White card holders are encouraged to make their own enquiries.
    Overseas visitors, or anyone not covered by Medicare, will be responsible for all charges including a $350 Doctor Consultation Fee.

    • +3

      Thanks for the info. $400 is hefty. I did ring the private hospital here in WA and was told to ring my insurer. Which I did. Who said I should ring the hospital. But gave me a very rough idea.

      • -2

        They are a business with share holders paying nurses $250k p.a.

        Someone has to pay.

  • +13

    Be careful when using private health insurance at a public hospital. Depending on your situation, it can cost you in the long run. For my situation, I had a broken wrist which I had surgery for. After I came out of hospital I required months of physio at the hospital which I was charged for. Had I gone in as public patient it would have been free. Best to check this before you go in to ensure you have all the information before making a decision.

    • -14

      Cool story but not related at all to OPs question

    • Thanks. Did you have a choice to get physio elsewhere?

      • Yes I did, but at a cost, whereby in hospital there was no cost.

    • Also important to check what the waiting times are for public as these services sometimes won't be instantly available.

  • +3

    A few visits to private ED in Adelaide hospitals, the cost has been between $350 and $500, not refundable from private health insurance, up front, but other costs were covered by Medicare/private health.
    It was worth it as both times coincided with ramping at the public hospitals.

    • Thanks. Good info. May I ask what other costs were incurred but covered? Eg. Bloods, scans.

      I heard from my insurer that everything before being admitted you pay for. Eg. If you just went in for a broken arm, attended to in the emergency room, and sent home, you pay for all of this.

      • Last time IIRC, bloods and x-rays, were covered.

    • @dashcam Second this re Adelaide.

  • +2

    I took my daughter to one because it was the closest (and I have insurance). Unfortunately we were sent to the public hospital because they were not equipped to deal with the problem.

    • I remember a story similar to this. Thanks.

  • AFAIK all private hospital E.D.'s charge their (non-claimable) base fee unless you are admitted, that's where your private health insurance takes over including that E.D. Fee.

    I have top cover health insurance and was recently taken by ambulance to a private hospital E.D.
    After examination and tests, but under much protest, I wasn't admitted. oop expense $230.

    Now I'm back in via ambulance again in more trouble due to the previous non-admittance. So far no mention of any costs after doc examination, bloods and a CT Scan, bed and nursing.

    [Gasp] What? You don't have insurance? [/Gasp]
    Don't get too sick or that gamble just might not pay off. My cover has paid out well over $100K in the recent past.

  • +2

    Much misinformation and extraneous information in this thread.


    You asked:

    I'm wondering what the out of pocket costs others experienced by attending an emergency department at a private hospital using their health insurance.

    See here:

    As [with] all Australian health insurers we're unable to pay benefits towards private or public hospital emergency department treatment, although a benefit will be payable under Medicare.

    Source: https://www.hif.com.au/help/health-insurance-information/wil...

    Based on the above, you have no private health insurance coverage in an emergency department in Australia.


    You also asked:

    From what I understand, you pay for everything up to being admitted to the hospital.

    Again based on the above link:

    Please note: If you visit an emergency department in a public or private hospital though, you can rest assured that this would be covered by Medicare. Private hospital emergency department services are claimable under Medicare from 1 March 2020.

    That is, Medicare will cover you whether in the emergency department of a private or public hospital.


    The situation changes if you are a foreign national and/or have no access to Medicare and/or hold overseas visitors health cover.

    • Thanks for that, my last experience with a private ED was Jan 2020. There appears to have been changes since then.

    • +4

      'covered by Medicare' does not mean 100% of the costs will be covered. The scheduled fee for the test/service will be covered and you will need to pay for whatever the hospital charges above that.

  • I'm curious about the intent to attend Private Emergency Department? Until today I was not even aware they existed, at least not in NSW.

    I can only speak from the perspective of ED experiences in NSW health system, so maybe other states have it differently or maybe their health system is in much worse shape than NSW one.

    What is the expectation wrt to private vs public emergency department? Bear in mind it is emergency department not I want to see handful of specialists and use bunch of expensive machines that go ping. From more than a dozen or so experiences (personal, family and friends) with various ED in at least 5 NSW public hospitals I can attest that every single time level of care received was absolutely appropriate (yes, even MRI scans performed and on-call specialists called to come in). Also in most cases triage was done in a spotless way, yes you would have to wait few hours if you had migraine and there was somebody who was just brought in by ambulance bleeding to death, but that is the gist of emergency department, patients are attended based on severity of their condition.

    So, again… what would be expected from private ED that properly funded and operated public ED could not provide?

    • +2

      Username doesn't check out

      what would be expected from private ED that properly funded and operated public ED could not provide?

      Wait times. Public can take forever. Private you will most likely be attended to straight away.

      • +1

        Again, I think that wait times are reasonable in NSW public hospital ED, as I mentioned, you will be triaged and attended based on your condition… Coming with a fever and a runny nose vs showing symptoms of a stroke will not get you the same prioritization… but there will be somebody to observe your fever and runny nose until they take care of the stroke patient.

        I doubt that any ED department (private, public, here, overseas…) has resources to attend to all patients at the same time regardless of the volume.

        • You shouldn’t be going to an ED with a migraine or runny nose and sore throat. They are not emergencies.

          • +1

            @iCandy: Apparently this is the problem, more so with certain immigrant populations for some reason (maybe the way it's done back home).
            I have thought about going to the ED once or twice just because my GP almost always has a +-7 day waiting list and trying to get a same day appointment within a 30km radius elsewhere was impossible just a few weeks back.

    • properly funded and operated public ED could not provide?

      In Tas there's no such thing as a properly funded and operated public ED. You'll want private to ensure a better chance of survival.

      • Sorry to hear that

        • Yeah ambulance ramping is a real issue. There's a couple of private EDs fortunately but only in the south of the state.

          • +1

            @Clear: In SA, the ramping was so severe recently that there were no ambulances available to attend emergency call outs and a young bloke died. Others were waiting for 90 minutes plus. This means/is due to huge backlog of patients in public ED.
            One private ED is at a hospital with a cardiac unit, another has a specialist orthopaedics.

            • +3

              @DashCam AKA Rolts: That's a summary of how a lot of it is happening here. Infact many people presenting to the ED get turned away and end up dying because they're too busy focusing on the addicts who go there 3 times a day and the countless people the cops bring in who can jump the queue.

              Years ago I was sent to the ED by a doctor for appendicitis and I wasn't seen for 5 agonising painful hours and was triaged as least concern. Literally on the ground screaming in pain because it had burst. I'm pretty cynical of the public system now.

              • -3

                @Clear: Mate, i felt for you because I was in the same predicament waiting 3 hours for someone to attend my appendicitis (and after my gp confirmed and sent me off). It was painful but no, frankly you would not die from appendicitis if it was a few hour wait and there're medical evidence backing that up. That's why they let you wait. Your statement of public system sent people home to die is over exaggerated. There were people got sent home and died because of generic symptoms but that was rare and those that made it to the news were just unfortunate, similar to the other end of the spectrum when someone win 20 mill lotto.

                • +2

                  @lgacb08: I notice you live in Melbourne. I work in the healthcare system in Tasmania and what I'm saying is true. Our public hospitals are notorious for people dying due to poor training, underfunded, lack of beds, ambulance ramping every day, lack of doctors, lack of specialists and lack of surgeons. I can't even have my own cancer treated in Tassie. I have to go to Melbourne for that because we don't have any advanced facilities to deal with anything out of the ordinary. Pre-covid the specialists would fly in every week.

                  A simple endoscope can have you waiting 2 years in the public system and a minimum of 9 months in the private system. Plus there's less than a dozen people who can perform it. How many do you think there are in Victoria who can do it? A lot more than a dozen. And how long do you think the waiting list is? I got in within 4 weeks as a private patient pre-cancer.

                • +1

                  @lgacb08: A ruptured appendix can lead to death . Peritonitis can quickly spread, resulting in septicemia, or bacteria in the blood. Your body releases chemicals into the bloodstream to fight this infection, triggering an inflammatory response throughout the body called sepsis. Not only appendix any internal organ burst could be lead to Death

                  • @denubunny: Yes, there're stories people died of rupture appendicitis but evidence also showed waiting for a few hours won't change much of an outcome that's why they let you wait.

                • +1

                  @lgacb08: Tatslotto is luck, medical treatment is not supposed to be. We wouldn't be paying it if we thought that.

  • +3

    Costs to walk into emergency regardless of cover ($4-500) and then hospital cover only kicks in on admission.

    In Adelaide, the major private A&Es like Calvary, Flinders, Ashford etc all take about the same loads as their public counterparts (with some exceptions). If the public system is Code White, the private will almost guaranteed to be in a similar shape.

    The benefits I've found is simply more choice especially if you're suffering chronic illness or serious episode. Using the dashboards, I can look and see where is best to go and if it's worth dropping $500 or not.

    Standard of care, time for bloods etc is much of a muchness if done on site.

    SA Public Dashboard
    https://www.sahealth.sa.gov.au/wps/wcm/connect/public+conten...

    Calvary Adelaide Dashboard

    https://care24-7.net.au/locations/adelaide/

  • +1

    my experience is they are not claimable under medicare (the out of pocket you pay is net of the standard rebate you get from medicare), and its not claimable by PHI as you're not yet admitted to hospital.

    However, if you've met your family safety net for the year, you get a shitload of it back as additional rebate - we did this and I think from a $480 fee, we were out of pocket maybe $100-150? Which was well worth it.

  • +3

    When I attended one I ended up about $800-900 out of pocket. There was the $400 or so attendance fee and then the fees for a bunch of tests. Was it worth it? I definitely felt like I was seen faster than in a public hospital and the whole experience was nicer and calmer. I still ended up being there almost a whole day though given how many tests they had to run and it still took hours for test results to come back. That being said, my Dr was very very through.

    Don’t regret it but the cost was certainly more than I expected. If I was cost conscious I’d got public as they still do a damn good job.

    • +2

      What tests, if you don't mind be asking, did you have to pay for?

      whole experience was nicer and calmer

      That last word is massive in my opinion. Nothing worse, than when you are trying to calm a loved one (eg. child, grandmother, etc - done both) and listening to abusive drug induced patients, with or without police escorts, sitting (or staggering around) in the same room, for hours on end.

  • Yes it’s expensive. Waiting times are less. There are some things that they can’t do and will send you on to public regardless. As someone else said if you want your follow up to be public sometimes you need to start in the public system.

    The only time I would consider it would be when the public system is beyond capacity. As has been seen recently. It really depends on what the issue is and where you live, a fracture/suspected fracture is probably one I would consider private ED for depending on the time of day, but I wouldn’t be looking forward to the cost!

  • +2

    In addition to the upfront fee, there may also be substantial gap fees. PHI pays for the hospital (bed, theatre hire) but for the doctors - you get 75% of the medicare scheduled fee. Also some sundries, like medications, are not covered.

    The doctors are not required to charge the scheduled fee, so the gap could be 25% of the scheduled fee plus a “surcharge” imposed by the doctor (surgeon and anaesthetist). Some insurers have ‘no gap’ agreements with some hospitals though. The gap payments can be costly. Public is completely free.

    The only real benefit of PHI imo is avoiding a long waiting list for elective surgery (eg - hip replacements, cataracts) and private EDs also generally have shorter waits. If you require emergency treatment immediately (heart attack, leg cut off, stab wounds in chest etc), you should go to the public ED and (if asked) say you want to be treated as a public patient. If you have something that doesnt need to be treated immediately (say an infected cut), worth going to a private ED so you don’t spend the day waiting and watching the more urgent cases go straight through ahead of you.

    Been in both, have had to share a room in private hospitals and the facilities no better but you pay. And there are no special private surgeons - the same people work in both systems.

  • +2

    I took my child to Epworth last night. Paid $400. Was it worth it, absolutely as the public hospital we went to was packed to the rafters with at least a 6 hour waitbto be seen. Sure we waited to be seen at the private hospital but we were waiting in a room in emergency with my son on a hospital bed and nurses taking his vitals every so often. Is it the Ozbargain way, no it isn't but it's convenient with a much, much shorter wait and the $400 was worth my time. Also on the off chance it was appendices, the private has a paediatric ward with paediatric surgeons so I preferred it anyways.

    • As I said above, given a choice between a hectic environment and a calmer one, when you have a child with you, I know which one I'd gladly pay for.

  • +1

    When my husband was a patient in a Private hospital and I would visit him with my daughter who works as a resident in a PH she was amazed at how many tests he was having and how quickly they were arranged. This was before Covid in Melbourne SE suburbs.

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