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Hospital bills and claiming

You won’t always receive a bill after going to hospital. If your procedure was included, you went to an nib Agreement Hospital and your doctors agreed to participate in MediGap then you may have nothing extra to pay. This simply means that nib paid the entire procedure on your behalf.

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

It’s important to understand that nib does not bill you for any part of your hospital stay.

Why did I get a hospital bill?

The hospital usually sends the bill directly to nib, but sometimes you may receive the bill after you leave hospital. You may get a hospital bill for the following reasons:

  • There were complications during your procedure and the additional services were not covered by your level of 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 are still serving the waiting period
  • The procedure is excluded on your cover
  • You were treated as an out-patient at the hospital or a 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 and they were charged at a rate higher than the MBS fee

If you are 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:

1. Two-way claim

If you received a bill from your medical services (for example, specialists, anaesthetist, pathology or radiology) a two-way claim is the easiest way for you to complete your claims after your hospital procedure:

  1. Complete a Medicare two-way claim form and a Medicare claim form and attach the specialist invoice indicating whether it has been paid or unpaid, then submit the claim to Medicare.
  2. Medicare will pay 75% of the Medicare benefit schedule fee and advise nib.
  3. nib will then pay 25% of the Medicare benefit schedule fee.
  4. Any remaining amount will then need to be paid by you to the specialist.

2. nib claim form with a Medicare Statement of Benefits

If you have already submitted your medical claims to Medicare you’ll need to send the Medicare Statement of Benefits and any receipts or invoices to an nib Retail Centre, or send us your claim directly.

If you have an unpaid account, Medicare and nib will arrange to make payment to your doctor. Whatever unpaid amount remains on the account (i.e. what Medicare and nib didn't 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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