Balancing Western Medicine and Alternative Methods

4 Reasons Why You Should Always Pre-Authorise Hospital Treatment With Your Health Insurer

Private health insurance allows you to choose to have your treatment in one of the 573 private hospitals across Australia, allowing you to quickly get the care you need. Nonetheless, before you have your treatment, it's generally a good idea to speak to your health insurer to pre-authorise the care. Find out how this can help you save money and get the right treatment.

You can confirm you have the available benefit

Australians can choose from several private health funds, and each insurer normally offers different plans to suit varying customer needs. As such, the amount of benefit available to you under your plan can vary significantly. Pre-authorisation allows you to confirm with the insurer how much benefit you have available and gives you an opportunity to find out what you may need to pay.

Things that can affect your coverage include:

  • Waiting periods. If your plan is quite new, you may not have coverage for certain benefits for some time.
  • Out-of-pocket/gap payments. Some hospitals expect patients to pay a fixed fee or a percentage of their treatment costs.
  • Benefit limits. Your insurance plan may only offer coverage up to a certain amount. If you have already claimed for treatment this year, you may have to pay some or all of the remaining costs yourself.

Pre-authorisation can also help you confirm ancillary benefits. For example, some plans allow parents to claim the cost of accommodation if they stay in hospital with a sick child.

You can make your coverage go further

Health insurers arrange discounts with certain hospitals and provider networks. If you pre-authorise your treatment, the hospital will often offer a better rate than the amount you would pay up-front. In turn, better rates allow you to get more from your benefit limits.

For example, if your plan includes a financial limit on physiotherapy claims, you can afford more sessions if your hospital agrees a discounted rate for each session with your insurer. Very often, you cannot benefit from these preferential rates if you don't pre-authorise the treatment, as this is part of the agreement between the private hospital and the insurer.

Your health insurer can also help you understand specific legal limits on your coverage. For example, if it's likely that you will need to stay in hospital for more than 35 consecutive days, you will need to pay for some of your treatment, as the Health Insurance Act does not allow insurers to pay these costs.

You will avoid nasty surprises

In some cases, your insurer may not have received payment for your health insurance. These billing problems are often quite easy to resolve, but until your insurer reinstates your plan, you cannot claim for treatment. As such, if you have hospital treatment and your insurer suspends your plan, the provider will ask you to pay for the treatment directly.

A quick pre-authorisation call to your insurer can help you avoid these nasty surprises. At a time when you need to focus on your health and recovery, the last thing you want to have to think about is an unpaid invoice.

You can benefit from direct billing arrangements

It's always easier and less stressful if the hospital can bill your health fund directly. What's more, private hospitals generally have ongoing accounts with health funds that make it quicker for them to receive payment too, so direct billing is in everyone's interests.

If you don't arrange direct billing, you may need to pay and then claim back your medical bills. According to the treatment you have, this means you could face bills that run into thousands of dollars, and some people can't easily lay their hands on that amount of cash. As such, pre-authorisation is a good way to limit the money you need to come up with.

Pre-authorisation with your health fund is not just an unnecessary, bureaucratic step. The next time you need treatment in a private hospital, pre-authorise the case with your insurer to make sure everything runs smoothly.