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Hospital bills and claiming

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You won’t always receive a bill after going to hospital. If your procedure was included on your cover, you went to an nib Agreement Hospital and your doctors agreed to participate in MediGap, Clinical Partners or performed a no gap procedure under GapSure then you may have nothing extra to pay.

If you do receive a bill it’s likely to be from one of three sources:

  • The hospital

  • The pathology or radiology labs associated with the hospital

  • The specialist or anaesthetist

nib does not bill you for any part of your hospital stay.

Why did I get a hospital bill?

Hospitals usually send bills directly to nib, but sometimes you may receive a bill after you leave hospital. This could be because:

  • There were complications during your procedure and the additional services aren't included on your cover

  • The hospital doesn't have an agreement with nib

  • You are within waiting periods for the procedure

  • The procedure is to treat a pre-existing condition and you're still serving the waiting period

  • The procedure is not included on your cover

  • You were treated as an outpatient at the hospital or day facility/surgery

  • The services weren’t covered or were only partly covered by the contract with the hospital

  • Your specialist/s charged above the MBS fee and did not participate in MediGap

  • You required radiology or pathology services that were charged above the MBS fee

  • Under nib’s GapSure Anaesthetics network agreement your anaesthetist charged you a permissible Known Gap that should not exceed $500

If you're unsure why you have been billed, please contact us.

If your specialist has agreed to participate in MediGap and not charge you out of pocket expenses but you received a bill, please call us.

How do I make a claim?

There are two ways you can make a claim depending on what the hospital or specialist has provided you with. (This does not apply to OVHC or OSHC members, who should send all bills directly to nib.)

1. Two-way claim

If you received a bill from your medical services (for example, specialists, anaesthetist, pathologist or radiologist) you should submit a Medicare two-way claim.

Complete a Medicare two-way claim form and a Medicare claim form, attach the specialist invoice indicating whether it is paid or unpaid, and submit the claim to Medicare. Medicare will pay 75% of the Medicare Benefit Schedule fee and advise nib, who will then pay 25% of the MBS fee. Any remaining costs will then need to be paid by you.

2. nib claim form with a Medicare Statement of Benefits

If you have already submitted your medical claims to Medicare, you’ll need to submit the Medicare Statement of Benefits and any receipts or invoices as a claim in your member account.

If you have an unpaid account, Medicare and nib will arrange to make payment to your doctor. Any outstanding amount (above what Medicare and nib pay) is what you pay to your doctor.

We can guide you through this process. Call us on 1800 098 783 to discuss your options.

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