6 secrets to reducing your out-of-pocket hospital costs

Tips to keep your out-of-pocket expenses down

28 September 2023 3 minute read

A woman signing some documents held out by another wearing scrubs

Nobody likes paying bills, especially when they include costs you could have avoided. When it comes to health care, there are definitely things you can do to make sure you're paying for the great quality care you need – and not a cent more.

To start with, you need to understand your policy – what it covers and what it doesn't. At nib, we believe that knowing what is and isn’t covered should be simple. With that in mind, here are a few tips to keep your out-of-pocket expenses down.

1. Know your out-of-pocket expenses and what isn't covered by Medicare

If they want to, specialists, pathologists and radiologists can charge more than the amount that Government deems as an ‘appropriate fee’ for their service. This ‘appropriate fee’ is called the Medicare Benefits Schedule (MBS) fee and the excess that a specialist or surgeon charges isn’t covered by Medicare. That means it may have to be paid out of your own pocket – it’s called a ‘gap’ or ‘out-of-pockets’ (learn more about the MBS here).

It’s always a good idea to request a written estimate of the out-of-pocket expenses from your specialist before agreeing to a procedure, however if you’d like some guidance, you can call 13 16 42 or log in to your member account and we can give you information on the procedure’s average out-of-pockets. Just click on the ‘Going to Hospital’ link to get started.

2. Check waiting periods

If you want to be treated in a private hospital or as a private patient in a public hospital, and have recently joined nib or changed your cover, you should find out whether there's a waiting period before you can claim.

There’s a two-month waiting period for most services and a 12-month waiting period for pre-existing conditions and pregnancy services. Log in to your member account or call nib on 13 16 42 to find out whether you need to serve any waiting periods.

3. Ask questions and do your homework

When you need to see a specialist, your GP will refer you and will order any tests you might need before you go. If you're concerned about how much it's going to cost, or aren't sure what you need, always ask for more information. Also, you don’t have to accept the specialist your GP is referring you to.

You can ask for an 'open referral' so you can go to a specialist you choose – a great option if you have friends or family who can recommend someone!

Some questions you might ask are:

What is the complete cost breakdown for my medical procedure?
Is the medical procedure fee an estimate or a fixed cost?
Are you a provider affiliated with nib?
Which hospitals do you offer your medical services at?
Are there any additional doctors or specialists involved in my procedure who will charge me additional fees?

Don’t forget to call us on 13 16 42 before your specialist consultation; we may be able to help you understand what the specialist charges on average for a procedure – including out-of-pocket expenses.

You can ask for an 'open referral' so you can go to a specialist you choose – a great option if you have friends or family who can recommend someone.

4. Take advantage of MediGap

Our MediGap Scheme is designed to reduce your hospital out-of-pocket costs. It's simple: we have a network of doctors, anaesthetists and specialists who may agree to charge us directly and ensure you don’t pay an out-of-pocket hospital expense. Before your procedure, ask your specialist whether they participate in the scheme. Alternatively, go to our Find a Provider page to check if your doctor is registered for our MediGap scheme and how frequently they participate.

5. Compare and review your hospital cover

Understanding what you're covered for with your private health insurance is key to making informed decisions, particularly when it comes to non-emergency procedures.

If you've opted for hospital cover, you'll enjoy the luxury of choice when it comes to selecting your specialist and hospital. Plus, you might find yourself facing shorter waiting times for elective surgeries.

Consider whether your current level of cover is the perfect fit for your lifestyle and life stage. Do you need to be covered for procedures like cataract surgery or dental surgery? Are there any waiting periods or coverage limits you should be aware of?

Regularly reviewing and comparing your health insurance cover is a smart move. You might discover that you're covered for conditions or hospital treatments that no longer serve you or your family's needs. Give us a call on 13 16 42 to chat through your options and find the appropriate level of cover.

6. Choose an nib agreement hospital

Good news, you'll pay fewer out-of-pocket expenses by choosing a hospital that is in our nib network. Often your specialist will select a hospital for you based on where they operate, but ask them if it's an nib agreement hospital to minimise your out-of-pocket expenses. If it turns out the hospital isn't on our list, you can ask your specialist to select one that is.

Use our Find a Provider tool to find a list of nib agreement hospitals near you.

Going to hospital?

If you’re an nib member going to hospital, it’s important to get in touch with one of our experts to help you navigate through any out-of-pockets, waiting periods and annual limits. Call nib on 13 16 42 and head to our Going to Hospital page so we can support you through the journey.