Private Health Insurance

There are many private insurance policies available, offering different levels of coverage. We encourage you to give your health fund a call prior to your admission, to find out your exact cover and whether your policy includes any additional costs such as an excess or co-payments.

Before you call, you should ask your doctor(s) for the item number(s) relating to your surgery.

  • Do I have to bill my private health insurer?

    Epworth will submit a claim to your private health insurer for the cost of hospital related expenses.

    Epworth will also submit claims for Department of Veterans Affairs (DVA) patients, WorkCover, TAC and other third party claims if a letter of liability is provided.

  • What is an excess or copayment?

    A hospital excess (also known as a deductible) is an annual out-of-pocket expense you pay when you are admitted to hospital before you can claim a benefit under your private health insurance policy.

    The hospital collects this excess on behalf of your health insurer. You only need to pay hospital excess once per person per year when admitted to hospital.

    A co-payment is a fixed amount you agree to pay each time your health insurer pays hospital benefits for you under your health insurance policy. For hospital admissions, a co-payment is payable for each day of hospitalisation up to a maximum annual amount.

    Excess and co-payment amounts can vary depending on your health insurance policy. For more details about applicable excess and co-payment amounts payable under your policy, please contact your health insurance provider.

  • What are item numbers, illness codes or clinical categories? 

    Item numbers refer to the Medicare Benefits Schedule (MBS) list of health professional services.

    Clinical categories set out the hospital treatments (MBS item numbers) that are, and are not, covered under each health insurance policy.

  • How do I contact my health fund? 

    Contacts for registered Australian health funds can be found here: https://www.privatehealth.gov.au/dynamic/insurer

  • What if I'm self-insured?

    If you do not have private health insurance an estimate of your admission costs will be calculated for you. You are required to pay your estimated account prior to, or at your admission. The actual cost incurred may differ from the estimate, due to a change in treatment or a longer stay in hospital than originally planned. If treatment costs exceed the estimated amount, you will be asked to pay the difference before going home. For further information, please contact the patient service centre of your admitting hospital.

Fees

  • What does Epworth charge? 

    Epworth HealthCare is Victoria’s largest not for profit private hospital group that charges fees for the services provided. Hospital services include nursing care, accommodation, operating theatre use, meals, and housekeeping.

    Epworth has agreements with many major Australian health insurance funds. Most hospital fees are covered by private health insurance, with the exceptions of excesses, co-payments, or exclusions.

  • Emergency Department fees

    Epworth Geelong - Emergency Department fees

    Initial consultation fees

    All private emergency departments will charge a flat fee for treatment that is not claimable under Medicare or private health insurance.

    Epworth Geelong charges a flat fee of $270 for an initial patient consultation.

    Out-of-pocket expenses

    Depending on your treatment, you may also incur out-of-pocket pathology or radiology costs, in addition to any consultation fees. A portion of these may be claimable under Medicare.

    Fees for international patients

    International patients who don’t hold a valid Medicare card will incur higher fees. An initial consultation fee of $490 applies to all international patients.

    Other associated fees must be paid up front.

    Please contact us for more information.

    Epworth Richmond - Emergency Department fees

    Epworth Richmond

    Epworth Richmond charges a flat fee of $400 per patient. This out-of-pocket fee is not claimable under Medicare or private health insurance.

    Depending on your treatment, you may also incur pathology or radiology costs, in addition to any out-of-pocket fees. If you hold a Medicare card, a portion of these may be claimable under Medicare.

    International patients

    International patients who do not hold a valid Medicare card will incur higher fees and are required to pay associated fees up front.

    The initial consultation fee for international patients is $500.

    Epworth applies a surcharge to all patient payments, including Emergency Department fees. This will apply to all credit and debit card payments.

    Read more information for international patients.

  • What non-hospital fees do I need to look out for? 

    All fees relating to medical practitioner care (excluding hospital fellows) and other non-hospital fees (see below) are charged separately.

    Non-hospital fees will be billed separately and may include:

    • Allied Health practitioners
    • Ambulance charges
    • Anaesthetist fees
    • Cardio-pulmonary bypass (perfusion)
    • Medical services
    • Pathology
    • Pharmacy
    • Physiotherapy (where no arrangement exists between Epworth and your health fund)
    • Radiology/X-ray
    • Surgeon fees

    Medicare refunds some non-hospital charges and your health fund may also cover a further portion, but you will be required to pay the balance. If you have any questions regarding these charges, please check with Medicare and your health fund.

  • Doctor's fees

    Please contact your doctor’s office should you have a question regarding fees charged by your doctor.

    It is your right to ask for information in writing regarding a doctor's professional fees before you receive any service or agree to a proposed treatment.

    Additional fees may include surgeon fees, surgical assistants, anaesthetists, medical services, imaging and other specialists.

  • Anaesthetist fees

    Both Medicare and private health insurance contribute to anaesthesia costs. Contact your anaesthetist to get an estimate of fees and your relevant MBS item numbers.

    As coverage for anaesthetist fees will vary according to your health fund policy, please get in touch with your health insurance provider and quoting the fee estimate your anaesthetist has provided to you and the relevant MBS item numbers, to receive an accurate estimate of the amount your fund will cover.

  • Hospital fees

    This covers the cost of your accommodation while you are in hospital. Fees include non-medical services, such as catering and housekeeping. You may also be charged fees for the use of an operating theatre or other hospital facilities while you are in hospital. It is not always possible to predict these fees in advance, as an unexpected surgery or referral may be necessary.

    Your hospital fee is generally covered by your health fund, except for excesses, co-payments and exclusions associated with your level of insurance cover.

  • Surcharge on card payments at Epworth HealthCare

    Epworth applies a surcharge to all patient payments (e.g. ED fees, private hospital excess). This will apply to all credit and debit card payments.

    See below, for rates that are applied:

    • EFTPOS (savings account – where card is inserted at terminal): no surcharge
    • VISA / MASTERCARD DEBIT (Paypass or tap): 0.5%
    • VISA / MASTERCARD CREDIT: 1.0%
    • Amex: 1.4%
    • Other: 1.65%

    The surcharge may not be incurred in certain areas within our hospitals (e.g. various cafés) as these are separate businesses to Epworth.

  • Payment of account

    You will be contacted by the hospital prior to your admission to inform you of any estimated out-of-pocket expenses that may apply to you. This may include excesses, co-payments and additional costs.

    All out-of-pocket expenses are required to be paid prior to or on your admission.

    Please remember to bring a form of payment with you upon your admission.

    Epworth accepts Visa, MasterCard, cash, bank cheques and EFTPOS. (NB: a surcharge on card payments may apply)

    We do not accept Diners Card or personal cheques. We do, however, accept American Express at some sites. If paying by card, please ensure any daily or transactional withdrawal limits are sufficient to settle your account.

Account enquiries / Contacts

You can submit an account enquiry online, or you can contact one of our friendly patient service team members who can assist if you have any further queries:

Epworth Eastern

Phone: 03 8807 7772
Email: [email protected]

Epworth Freemasons

Phone: 1800 337 453
Email: [email protected]

Epworth Hawthorn

Phone: 03 9415 5720
Email: [email protected]

Epworth Richmond

Phone: 03 9426 8844
Email: [email protected]

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