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Who pays for what when it comes to your medical bills?

A simple guide on who's responsible for healthcare costs


When it comes to paying a doctor or specialist bill, it can be confusing to work out who pays for what.
At nib, we believe that understanding your health cover should be simple; so, we’ve put together a table to guide you on who’s responsible for your health costs.

For more information visit our article What’s the difference between private health insurance and Medicare.

What do I have to pay for in hospital if I have private health insurance?

As a general guide, if you’re an inpatient using private health insurance, your insurer will cover most of the costs, including specialist fees, doctor’s fees, accommodation, hospital meals, theatre costs and other treatments. You may have to pay an ‘excess’. With nib, our policies usually have the option of $250 or $500 excess. From 1 April 2019, you'll be able to increase your excess to $750 as part of the private health insurance reforms.

Some doctors charge higher amounts than others and if your doctor charges more than what Medicare deems an ‘appropriate fee’, you’ll be responsible for paying the gap. For more information on this, check out our article Why do I have to pay a gap when being treated in hospital?

If you’re an nib customer 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.

Want to make sure you’re not paying more than you have to for your dentist, optometrist and physiotherapy appointments? Make sure you check out our First Choice Network – a community of specially selected health providers who’ve agreed to provide nib customers with quality healthcare and great customer service at an affordable price.

If you’ve got Amazon Alexa, you can use the nib Skill to find healthcare providers in your area, get daily health tips and answer your biggest health insurance questions. It’s as easy as saying ‘Alexa, ask nib…’ Visit our dedicated page to find out more about the nib Skill available on Alexa.

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