PRIVATE HEALTH INSURANCE: WHAT DOES MY HEALTH FUND COVER?

You may have elected to have a private health insurance policy.

Having private health insurance means you may be eligible for private health fund rebates.

Patients who are covered by private health insurance have reduced out of pocket costs associated with surgeries conducted in a private hospital setting, including IVF treatments.

Private Health Insurance helps patients by covering day hospital expenses which are not covered by Medicare. 

PRIVATE HEALTH INSURANCE IS A CONTRACT BETWEEN A PATIENT AND THEIR INSURER

There are many different Private Health Insurance Providers and health Insurance Policy that health insurance customers (our patients) may select from.

The Insurer you have chosen and the level of private health insurance policy you have elected to enrol in and pay for influences the rebate amount for which you are covered for hospital admissions.

If you do not have private health insurance, you can decide to self fund your private hospital admission, surgery and anaesthetic costs. Transparent cost information will be attained for your both from WHM and also our Day Surgery Partners at Ramsay Hospitals Masada (Balaclava) and  Frances Perry (Parkville) and Epworth Freemason’s (East Melbourne).

Anaesthetic costs:

You will be put in contact with the administration team of the specialist anaesthetist who will care for you during your procedure and will be provided with informed financial consent for their billing practices, which are external to WHM. Anaesthetic services generally incur out of pocket costs.

WHM strongly advise you to contact your health fund for advice about your rebates for gynaecology, obstetrics, IVF and  any relevant waiting periods that may affect the out of pocket costs for your surgery or fertility treatment arranged together with our WHM  and Life Fertility Clinic Melbourne team.

TREATMENT MEDICARE ITEM NUMBERS

For your convenience, the following item numbers are frequently required for treatments advised via WHM:

Where multiple item numbers are listed, different item number refer to the degree of complexity of your planned procedure. Exact item numbers are confirmed on the day of surgery once the scope of the procedure that was necessary on the day of surgery has been confirmed.

  • Laparoscopic surgery: 35631, 35632, 35643, 35637

  • Hysteroscopic surgery: 35630, 35633, 35636, 35635

  • Miscarriage management: 35643

  • Assisted Reproductive Treatments:  13212, 13215

WHAT DETAILS DO I NEED TO PROVIDE TO WHM SO THAT I CAN BENEFIT FROM MY PRIVATE HEALTH INSURANCE?

Please provide your private health insurance company name and membership number. You should seek advice from your health fund so that you can understand the contribution to your care costs for whch you are eligible under your health insurance policy.