Medibank Private
Medibank Private have partnered with our Healthe Care Hospitals offering No Gap Hip & Knee Joint Replacement Surgery; Anterior Cruciate Ligament (ACL) Repair Surgery; Hernia Repair Surgery; Colonoscopy and Gastroscopy.
Medibank Private Frequently Asked Questions
What if there are complications?
If there are complications during your hospital admission that require additional care or services beyond what is included in the no-gap program, fees may apply. An example of this includes needing to be transferred to another hospital. Please speak with the Participating Medical Provider to confirm and ensure a valid Informed Financial Consent is given.
What is pre-admission joint school?
Hospitals participating in the no-gap joint replacement program offer patients the opportunity to attend a pre-admission joint school.
The pre-admission joint school is run by participating hospitals and surgeons, and may include things such as:
A hospital tour and the opportunity to meet the team of staff that will be looking after during your hospital admission
Information on exercises to perform both before and after your surgery
Education on mobility aids such as crutches or anything else you may need when returning home
It’s best to contact your participating hospital or surgeon to find out what services are included in the pre-admission joint school offered by your participating hospital.
What if I need rehabilitation?
Your participating surgeon will work with you to decide if you need rehabilitation after your surgery and if so, what type of rehabilitation is right for you.
If clinically appropriate, your surgeon may refer you to a provider who can deliver rehabilitation in the comfort of your home. Participation in a rehabilitation at home program is subject to the availability of a rehabilitation at home provider.
If rehabilitation care in an inpatient setting is required, we will pay benefits towards your hospital accommodation at a Members Choice Hospital and you will incur no out-of-pocket costs except for any per-day payment under your policy or any associated hospital costs like parking. There may be a cost associated if you are treated by a Rehabilitation Physician or require diagnostic tests, however the doctor will need to provide you with informed financial consent.
Things you should know
* There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms.
An excess or per day payment may still be payable, depending on the type of cover you have and whether you are claiming under your hospital cover for the first time in a calendar year. Please contact Medibank on 1300 733 338 to check your product eligibility and level of cover.
*Excludes joint replacements resulting from an emergency admission.
How does the program work?
This doctor-led and designed program offers an early-to-home discharge, where clinically appropriate, that is designed to provide members with more choice and transparency on affordable care options when undergoing a joint replacement at participating hospitals.
Eligible Medibank members may also have access to additional support before and after their surgery, such as pre-admission joint school, and options for in-home nursing care or rehabilitation with physiotherapy and other allied health support if their treating doctors considers it to be clinically appropriate and subject to the availability of at home care providers. Your participating surgeon will work with you to determine if this care is right for you. Contact your surgeon or click the following link to find out more.
Is the program right for me?
Medibank members must have hospital cover with joint replacement included in their product and have served all applicable waiting periods. The program must be clinically appropriate. Please contact us on 1300 733 338 to check your product eligibility and level of cover.
Your participating surgeon and the hospital will work with you to decide if the pilot is right for you and your health needs.
The no-gap joint replacement pilot program is only available at participating hospitals with participating surgeons.
Which hospitals and surgeons are participating?
Currently, the program is available at participating hospitals for Medibank members undergoing a joint replacement. It’s best to contact the hospital directly to check which surgeons and surgeries are included in the program:
- Hurstville Private Hospital
- Shellharbour Private Hospital
- Maitland Private Hospital
- Lingard Private Hospital
- Dubbo Private Hospital
- Mulgrave Private Hospital (Melbourne)
- Mayo Private Hospital (Taree)
- Forster Private Hospital
- Healthwoods Endoscopy Centre
- Hobson Healthcare (Sydenham & Werribee)
- Wollongong Day Surgery
What out of pockets will I have?
Eligible Members participating in the program will not incur out of pocket costs for the following services as part of your hospital admission at participating hospitals:
- Pre-admission joint school (where applicable)
- Hospital accommodation and theatre costs
- Surgeon
- Anaesthetist
- Surgical assistant
- Diagnostic tests (where required)
An excess or per day payment may still be payable, depending on the type of cover you have and whether you are claiming under your hospital cover for the first time in a calendar year. Please contact Medibank on 1300 733 338 to check your product eligibility and level of cover.
No Excess Product Information
Members who are on the following products* – Medibank Silver Plus Support, Medibank Silver Plus Secure or Medibank Gold Protect, are eligible for the No Gap program and have served relevant waiting periods, will not have to pay an excess for their No Gap admission. If eligible, this is claimable once per adult Member per calendar year. For any subsequent claims within the calendar year that are not a Medibank No Gap procedure, the Member will need to pay the standard excess per their product.
General exclusions for No Excess for No Gap:
- Any procedure at a contracted hospital that is not part of the agreed No gap procedures.
- Any procedure outside of a contracted hospital network where a surgeon does not charge above the MBS.
- Any ‘known gap’ treatments.
If you are on one of the above-mentioned products and want to confirm if No Excess applies to you, please contact Medibank’s Customer Health Support team on 1300 733 338.
* The product names outlined here are accurate at time of publishing but subject to change
If a Member seeks additional services beyond what is included in the no-gap joint replacement pilot program, fees may apply. You may incur fees if medication is prescribed during your hospital stay that is not included on the Pharmaceutical Benefits Scheme or for services that are for your comfort or convenience, such as if you wish to be transported by ambulance to a hospital closer to where you live and dry-cleaning of non-hospital items. Please speak with the Participating Medical Provider to confirm and ensure a valid Informed Financial Consent is given.
If rehabilitation care in an inpatient setting is required, we will pay benefits towards your hospital accommodation at a Members Choice Hospital and you will incur no out-of-pocket costs except for any per-day payment under your policy or any associated hospital costs like parking. There may be a cost associated if you are treated by a Rehabilitation Physician or require diagnostic tests, however the doctor will need to provide you with informed financial consent.
There may be out-of-pocket expenses associated with outpatient appointments, such as your initial visit with a participating surgeon in their consulting rooms. Please speak with your participating surgeon to find out more.
Disclaimers
The listing of a provider does not comprise any sort of representation or recommendation by Medibank regarding the provider. To the fullest extent allowed by law, such reference should not be construed as:
- an endorsement by Medibank; or
- commendation for the status of the provider’s registration with their registration bodies like the Australian Health Practitioner Regulation Agency (AHPRA); or
- a recommendation or warranty by Medibank of, for or in relation to the provider’s services.
Accordingly, Medibank neither takes nor assumes any responsibility for the services provided. Members should rely on their own enquiries and seek any assurance or warranties directly from the provider in relation to the service or with the registration bodies (e.g. AHPRA) regarding any conditions or restrictions to the provider’s registration.
Information presented is refreshed regularly. Information is accurate at time of publishing.
