Going to hospitalYour GuideWhether your visit is planned or unplanned, use this guide to help develop your care plan or understand what to expect.

Talk to us before you go to hospitalCall our friendly team on 134 135, message us on myBupa or pop into your local Bupa store.

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ContentsIntroduction to healthcare How Australia’s healthcare system works 3Who delivers healthcare 4Who pays for healthcare 5What to do when you feel sick 6Preparing for an emergency 7Visiting a specialist 10

Your health and wellbeingPreparing for your planned hospital admission 15Looking after your health before your admission 16Key steps before your admission 18Preventing medicine mistakes 22During your stay 23People you may meet 24Preparing for your treatment or surgery 25Informed consent 25Managing nerves 26What to expect after your treatment or surgery 27Getting a good night’s sleep in hospital 29Discharge from hospital 30Preparing to go home 30Questions to ask about your recovery 31Managing your medicines 32After your stay 33What to watch out for 34

Your coverHospital versus medical costs 36Costs you might not be covered for 37Preparing financially for your stay 40What is Bupa’s Medical Gap Scheme? 42Bupa – bringing you greater value and certainty 43How to claim 45We’re here to help 46

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How Australia’s healthcare system worksAustralia’s healthcare system is complicated and navigating it can be confusing. If you need hospital treatment, understanding how it works can help you make informed decisions to get the best care for you or your family.

The healthcare system at a glanceOur healthcare system is one of the most comprehensive in the world; offering a range of services from general and preventative health, through to treating more complex conditions, that may need a specialist, or hospital care.

The system has two major parts: the public health system, and the private health system. When you need healthcare, you could access it through one of two systems, or a mix of both.

The public system is made up of number of components, including public hospitals, community-based services, and affiliated health organisations largely owned and governed by state and territory Governments. The Australian public access care within the public health system for free or at a lower cost through Medicare (funded by tax).

The private system includes health service providers that are owned and managed privately, such as private hospitals, specialist medical and allied health, and pharmacies.

The services you access through the public system are funded by local, state and federal Governments, but the services you access through the private system are funded by a combination of Government and private entities, including:

• Private health insurance premiums – paid by customers

• Private health organisations

• People paying directly for private treatment

• Government incentives on private health insurance

• Other Government and private funding

In the lead up to, and during a hospital visit, health professionals, including doctors and specialists, can provide treatment through either the public or the private system.

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Who delivers healthcare

SpecialistsA medical specialist is a doctor who has a high level of education and training in a specific area of medicine, for example, a cardiologist specialises in treating heart conditions. Private hospitals

Private hospitals also provide high quality medical care for patients. They may also offer a range of wider health and care services.

These hospitals are owned and operated by private organisations but licensed and regulated by the Government.

Typically, you’ll have a choice as a private patient for your care like choosing your doctor, reduced waiting times for elective or planned surgery and the choice of a private room (if available and clinically appropriate).

You can also be treated as a private patient in a public hospital, treated by your choice of doctor.

Public hospitalsPublic hospitals provide high quality medical care at low or even no cost to people with access to Medicare. They are usually where you go in an emergency.

If you need non-urgent treatment and choose to be a public patient, you may need to wait longer for surgery, you won’t be able to choose your doctor and may be in a shared room with others while you recover.

Public hospitals are funded by the Government, but also get funded by health insurance when patients choose to use their private cover in a public hospital.

General Practitioner (GP)General practitioners (GPs), are often your starting point when it comes to health and care.

They will assess any problems that may present and try to treat your immediate health concerns. If needed, they can also arrange for tests to help with their diagnosis e.g. blood samples. Sometimes they may refer you to a specialist, hospital or allied health professional e.g. physiotherapist.

Allied health professionalsAllied health providers are generally health professionals that are not doctors, nurses or medical professionals. They are usually qualified and focus on preventing, diagnosing and treating a range of conditions.

Some examples include psychologists, occupational therapists, radiographers, pharmacists and podiatrists.

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MedicareMedicare is the Australian Government’s scheme to give the public access to healthcare (paid by taxpayers) and it covers:

• Treatment as a public patient in a public hospital

• 75% of the fee on a Government list called the Medicare Benefit Schedule (MBS) for doctors’ services in hospital if you’re a private patient

• All (what’s known as ‘bulk billing’) or some of the cost of going to a GP or specialist

• Some (but not all) tests and examinations your doctor orders for you

• Reduced cost on some prescription medications, if they are on an Australian Government list called the Pharmaceutical Benefits Scheme (PBS)

There is a list of services subsidised by the Government. Each has a fee that the Government says is appropriate to charge for that service. This list is called the Medicare Benefits Schedule (or MBS).

Find out more at mbsonline.gov.au. Your doctor or specialist may choose to charge more than this fee, which may lead to a remaining amount to pay.

Private health insuranceYour health cover with Bupa can include coverage for:

• Hospital treatment: Once you are admitted to hospital, private hospital cover will help pay for the costs of treatment and your stay. Medical costs may be reduced using Bupa’s Medical Gap Scheme.

• General treatment: Also called ‘Extras’, or ‘Ancillary’ this depends on your policy but can include dental, optical and physiotherapy treatments. For example Extras cover could also include:

• Ambulance: You could get cover for emergency, and sometimes non-emergency transport and/or treatment. In some states, an ambulance may already be covered or cover can be purchased by a subscription directly from the provider.

To learn more about your Bupa cover, see your policy information or read our Important Information Guide at bupa.com.au/retail-info for domestic and corporate covers.

Or bupa.com.au/visitors-info for overseas visitors, or

bupa.com.au/oshc-info for overseas students.

Who pays for healthcareDepending on how you use the healthcare system, funding comes from the Government, as well as private health insurers, and sometimes – from you.

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What to do when you feel sick

If you’re not sure if it’s an emergency health issue, it’s better to treat it as an emergency. If you need more advice about your health issue, you could also:

• See a GP

• Visit healthdirect.gov.au

• Call the Australian Government’s health advice line on 1800 022 222

If it’s a mental health issue, you can also call LifeLine on 13 11 14.

Visit your local hospital emergency department

Call 000 (triple zero) for an ambulance

Emergency health issues

Non-Emergency health issues

Visit your local GP or medical centre

GP refers you to a specialist or other health service

Receive treatment from your GP

Do some countries have access to Medicare?Yes, the Australian Government has Reciprocal Health Care Agreements (RHCA) with a selected number of countries. These agreements enable residents of these countries to receive Medicare benefits when visiting or working in Australia.

The level of Medicare cover and the period for which you receive it varies depending on which country you are from.

For more information and for a list of countries visit humanservices.gov.au or contact us.

Choosing a hospital? Call us firstWe recommend you call us first on 134 135 to discuss your hospital options and to get the most out of your cover. You can also find out if a hospital has an agreement with us by visiting bupa.com.au/find-a-provider

Tips to prepare for an emergency

No one wants to deal with a medical emergency, but the reality is that sometimes they’re unavoidable. With a few key tips, you can be prepared and make the best possible choices for you or your family, even in the trickiest of circumstances.

1Create a list of important details and keep it somewhere handy. It’s a good idea to have the address and phone number of your closest hospital written down somewhere handy, perhaps on the fridge, as well as other helpful emergency contact numbers, such as the Poisons Information Hotline. You should also have your partner and close family members’ contact details written down, in case your phone isn’t accessible in a medical emergency, as the hospital may need to contact them.

2Download the Emergency+ app so you’ll be able to reach emergency services and provide them with your location digitally, even when mobile reception is bad or you’re not sure exactly where you are.

Visit emergencyapp.triplezero.gov.au for more info.

3If you have kids, teach them how to call Triple Zero (000) and what to say to the operator. The Triple Zero Kids’ Challenge is an online game that can help young Aussies learn how to respond to an emergency in a fun, age-appropriate way.

Visit kids.triplezero.gov.au to play.

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Preparing for an emergency

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Policy and Fund Rules apply. See your policy information for further details.

Ambulance costsSometimes, in an emergency, an ambulance may be needed. If you do need an ambulance, it’s important to know what your options are in paying for ambulance services.

Medicare doesn’t cover ambulance costs. When it comes to ambulance services, each state runs their own services. Your options are listed in the table below.

It’s worth noting:Some states offer free or subsidised ambulance services to pension and concession card holders. Check your state Government website for more details.

Some states have agreements with other states to cover their residents, and vice versa. This varies, so if you travel interstate frequently, it could be worth considering private cover (if not already) or a subscription.

Some covers, subscriptions and agreements between states only offer cover for Ambulances by road, and not air. It’s worth checking the detail of what they’ll cover, before making your decision.

State you normally live in Options to fund Ambulance services

ACT

NSW

Metro WA & Norfolk Island

• Pay yourself.

• Use Private cover (included in most Hospital or Extras covers).

Country WA

VIC

NT

SA

• Pay yourself

• Use Private cover (included in most Hospital or Extras covers).

• Get an Ambulance subscription.

TAS

• The Government covers you everywhere, except for in QLD and SA.

• If you travel to these states frequently, you could consider private cover, or you’ll need to pay these costs yourself.

QLD • The Government covers you everywhere in Australia.

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If you are taken by ambulance to a hospital emergency department (sometimes known as the ED, Emergency Room, or ER), most emergency departments are in public hospitals in Australia, you’ll be assessed by a triage nurse to determine the priority of your treatment. This helps make sure that the most sick or injured patients are seen first.

Make sure you tell the nurse important details such as any allergies, current medication and treatments, past health problems and any recent overseas trips. Also, let them know if you’re pregnant or breastfeeding.

If the emergency department is busy and there are lots serious cases ahead of you, you may be asked to wait in the waiting room. Make sure you let the triage nurse know if your condition changes.

When it’s your turn, you’ll be taken to a treatment area to be assessed and treated. If staff can treat you in the emergency department, you’ll be able to go home afterwards. If the problem is more serious or needs ongoing care, you’ll be admitted to hospital, known as an inpatient.

Using your Bupa cover in a public hospitalIf you’re admitted to a public hospital, one of the questions you’ll likely be asked is whether you have private health insurance. It’s entirely up to you whether you choose to use your health cover or not in a public hospital. This is a choice protected under the National Health Reform Agreement.

If you choose to use your Bupa cover:• You have the right to be treated by

your choice of doctor.

• You may get your own room if one is available. It’s important to remember though, that public hospitals give these out based on clinical need, and in a public hospital, there may be less private rooms available.

However, there are some things you may need to be aware of if you use your private cover in a public hospital.

For example:• In an emergency, you’re unlikely to get to

choose your own doctor.

• If you have an excess, you may need to pay it. Some hospitals will offer to pay it for you.

• Your doctor might charge you a higher fee (above the MBS) which may not be covered by Medicare or your health insurer.

Arriving at a hospital

To make an informed decision, make sure you ask the hospital these key questions:• What are the benefits if I use my

private health insurance?• Will there be any difference to my

care if I use my private cover?• Can I choose my doctor?• Can I get a private room?• What costs will I incur if I do

choose to use my private health insurance either in hospital or after I leave?

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You don’t need a referral to see a specialist but not having one may mean extra costs and some details missing about your health that normally will come from a referring doctor.

Before you leave your doctor with a referral letter, you might want to:

Why do I need a referral from a GP?Your GP or specialist will provide you with a referral if your condition needs specialist care that your referring doctor can’t provide.

Treatment OptionsThe treatment options you and your doctor would like to explore may influence which and what type of specialist you choose.

Specialist feesSpecialist fees can vary from doctor to doctor, and may not be easy to determine until you have that initial consultation with your medical specialist.

The hidden waitlistA specialist referral is often made without any idea of how long you are going to have to wait, especially if your condition is not urgent.

Ask your GP• For the name(s) of a recommended

specialist.

• About specialist options in either a public hospital clinic or a specialist private consultation room, as the pathway you choose may impact on your wait times and potential out-of-pocket costs.

• For referral letter(s) to recommended specialist(s).

• About the timeframe for consultation period (e.g. 6, 12, 18 months or indefinite).

• About any fees you may have to pay when you see a specialist.

Ask your specialist• About your treatment options.

• About specialist options in either a public hospital clinic or a specialist private consultation room, as the pathway you choose may impact on your wait times and potential out of pocket costs.

• For referral letter(s) to recommended specialist(s) if you would like a second opinion.

• About any fees you may have to pay.

• About when you need your next appointment.

Visiting a specialist

Who pays for a specialistWhen you are eligible for Medicare and have a referral:Medicare will reimburse you for a portion of your specialist consultations and treatments.

When you are eligible for Medicare and don’t have a referral:You’ll pay in full for all specialist consultations and treatments.

Does Bupa cover specialist costs?Out of hospitalNo health insurer in Australia can cover this as set out in the Health Insurance Act 1973.

In hospitalYes, depending on your cover. See your policy information for more information.

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6 important things to note about a specialist letter

1 2 3The clock starts ticking on the date of your first consultation, not the date on the letter

Your referral letter expiry date starts from the date of your first consultation with your specialist, which can be quite confusing. This affects how long your referral is valid for and when you will need a new referral letter.

Your referral letter does not have to be addressed to a named specialist

The letter can either be addressed to a named specialist or to a specialist type. (e.g. “Dear Cardiologist). Your doctor could instead provide you with multiple referral letters to different named doctors in the same specialty. This gives you the flexibility to investigate which specialist might suit you best, without having to keep going back to your referring doctor.

How long your referral letter stays valid depends on who wrote it

From your GP: your referral will be valid 12 months unless your GP indicates a different time period (e.g. 3, 6, 18 months or indefinite).

From your specialist: your referral letter will only be valid for 3 months after your first consultation with another specialist.

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4 5 6One letter for one specialist and one treatment

You cannot use the same referral letter you have already used to attend a specialist appointment again to see another doctor. You will need to ask for a referral letter for any new specialist you would like to see.

It is against the law for a GP or referring doctor to backdate a referral

The doctor issuing the referral may face charges and penalties.

Your specialist may ask you for a new letter

If your original letter has expired and you need ongoing treatment your specialist may ask for a new letter. In addition, they may ask you to go back to your GP if they feel you need an ongoing referral or if you have a new or unrelated medical condition.

A new letter may also be required if you saw your specialist more than 9 months ago.

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Tip: Keep the receipt of your doctor visit in case you lose your letterMedicare will still reimburse you for your first specialist consultation if you can provide a receipt that shows the name of your referring doctor, practice address, provider number and the words “lost referral”.

Your health and wellbeing

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Learning about your hospital admissionLearning more about your hospital admission, and your pathway to recovery, can help ensure you get the best care for your needs.

There are many things you may want to consider when you are about to go to hospital.

For example:• What are the benefits of having

the treatment?

• How well is the treatment or surgery likely to work for you, given your age and any health conditions you may have?

• What will the treatment involve?

• Are there any side effects or risks associated with it?

• Will a prosthesis (device) be used? If so, is this device the best option for you?

• How long has the device been in use and what is its track record?

• Is the device registered with the Therapeutic Goods Administration (TGA)?

• Will you have a scar after the procedure? And if so where and how large will it be?

• How long will you need to stay in hospital?

• What are your recovery or post-surgery options?

• Will your day-to-day functioning be affected after the treatment?

• Will you need to have any follow up visits after the treatment?

• How long will I be away from work or other duties?

You can discuss these details with your doctor if you are uncertain.

Information your doctor may need to knowTell your doctor:

• About any medical conditions or illnesses you may have.

• If you have any known allergies, especially to any medicines (e.g. antibiotics, anaesthetics, etc.).

• About all the medicines you are taking, including prescribed, over-the-counter, or complementary.

• If there is anything you are fearful of (e.g. experiencing pain after the procedure, side effects of the anaesthetic).

• If you are - or may be - pregnant, or if you are breastfeeding.

Preparing for your planned hospital admissionOnce you know you will be going to hospital, it’s important to do some planning and preparation to make sure your stay goes as smoothly as possible.

Use these tips and checklists to help you prepare.

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Looking after your health before your admissionWork with your doctor(s) to be as fit and healthy as you can before your admission. Here are some things you may need to focus on.

Physical assessmentYou may need to have a physical examination and undergo some tests (e.g. blood tests).

You will need to complete some forms to identify any risks, to make sure you are fit for your treatment or surgery and anaesthesia. Many hospitals offer a pre-admission service to make this process smoother. This is conducted in person at the hospital or over the phone, depending on your circumstances.

My plan:

MedicationMake sure you are taking all the medicines you need to.

Check with your doctor to see if you should stop any medicines (both prescription and non-prescription), start anything new or change the dose of something you already take. This is particularly important if you are on anticlotting medicines (e.g. aspirin; warfarin) and/or diabetes medicines (e.g. insulin; metformin).

My plan:

Your other conditionsFind out about how other health conditions you may have (e.g. diabetes; heart disease; asthma) will be managed in hospital and if there are any changes you may need to make to your management plan.

My plan:

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Quit smokingSmoking increases your risk of complications after a procedure, and can impact on your body’s ability to heal. Ask your doctor or pharmacist for help to stop smoking or call Quitline 13 78 48.

If you decide to try nicotine replacement therapy (NRT) and you have Extras cover that includes Health Management benefits, you may be eligible to claim for it. For more information, look up NRT on bupa.com.au or call Bupa on 134 135.

My plan:

ExerciseIf you are having surgery, for example hip or knee replacement, find out if there are any exercises (e.g. muscle strengthening) you could do before your procedure to help speed your recovery afterwards.

Some exercise is better than none.

To find out how Bupa can support your recovery and rehab needs, visit bupa.com.au/member-support

My plan:

Nutrition Make sure to eat well, as good nutrition can have a positive impact on your health and recovery. For more information on healthy eating, visit bupa.com.au/healthlink

Your GP can refer you to a dietitian if required.

My plan:

Contact Bupa before your admissionAs soon as you know you’ll be going to hospital, contact us on 134 135 to help make sure you get the most from your cover, and find out if any excess and/or out-of-pocket payment will apply to your admission. See page 46 for more information.

Fill in your pre-admission paperworkYour hospital paperwork, including a Patient Registration Form and Patient Health History form, may be completed online or in hard copy after discussing your admission with your doctor. The forms must be received by the hospital no later than 48 hours before your admission.

See your hospital’s Admission Information for instructions. Staff in your doctor’s rooms can also provide instructions to assist with your online admission.

Request your own private roomIf you would like a private room, you will need to request one from your hospital at least 24 hours before you are admitted. If you are going to a Member’s First Hospital, and there are no private rooms available, you will receive $50 back from the hospital for each night that a private room is unavailable (conditions apply).

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Here is a list of other things to do before your admission. Any preparation, big or small, can make a difference to your wellbeing during your hospital stay.

Key steps before your admission

Your hospital’s Admission Information booklet will usually have a detailed checklist of relevant and important items to bring with you to hospital.Consider what you could bring in addition to the essentials to help make your stay more comfortable or to help the time pass, such as a good book or some magazines.

PackGet your hospital bag ready ahead of time so so you can organise everything you will need for your hospital stay.

• Dress comfortably, and pack sleepwear, underwear, and toiletries.

• Remember your medicines — pack all the medicines you’re taking in their original packaging (see box on page 22 for further information).

• Don’t apply or wear items that will need to be removed before the procedure (e.g. makeup, nail polish,or jewellery). Any jewellery that cannot be removed will be taped over, but it may need to be cut off in an emergency.

• Leave valuables at home but do bring a small amount of cash or a credit card to pay for incidentals that may be required.

Follow pre-operative instructionsRead and carefully follow any instructions you receive from your surgeon and the hospital regarding bathing, fasting etc. They are for your safety and convenience.

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Admission checklistThe questions you should ask on being admitted to hospital.

Find out your expected discharge date.

My plan:

Ask whether you are likely to need additional support services (e.g. physiotherapy).

My plan:

Prepare your home for your recovery (e.g. store items you know you are likely to need within easy reach, and think about any stairs you have). Stairs can be particularly hazardous and should be avoided if you are not feeling well or do not have caregiver assistance.

My plan:

Find out if you’re likely to need a home visit or any home modifications (e.g. hand rails installed).

My plan:

Find out if you will need any equipment to assist you with your personal or domestic activities of daily living (e.g. a shower chair, or an over toilet frame).

My plan:

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If you live alone, think about who may be available to assist you at home with daily personal and domestic activities if needed — particularly in the early days after discharge from hospital.

My plan:

Plan your meal options — good nutrition is important for your health. You might like to cook and freeze some meals for when you return home.

My plan:

Plan how you will safely get home from hospital (e.g. arrange for a carer, friend or relative to collect you).

My plan:

Find out if you’re likely to need a home visit or any home modifications (e.g. hand rails installed).

My plan:

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If you are unsure about any of the items above, you may like to speak to the nurse, discharge planner, or social worker in hospital as they can help you make home-based or alternative arrangements if necessary.

The following steps can help prevent medicine mishaps around the time of going to hospital.

Before your hospital stay, confirm your complete list of medicines (prescription and non-prescription) with your pharmacist and/or doctor as well as your pre-admission nurse and note any details you need to know about them (e.g. what the medicine is for, how much to take, and when to take it).

Take all your medicines with you to hospital, including prescription and non-prescription medicines (e.g. over-the-counter painkillers, vitamins, herbal, natural, or alternative). Some people prefer to have their medicines already divided into individual doses and blister-sealed into a dosing aid such as a Webster-pak® for convenience. To find out more about this service, talk to your local pharmacy.

Make sure you give the nurse or doctor at the hospital who admits you the complete list of your medicines, which the hospital staff can use to record any changes they make to your medicines during your stay.

Tell hospital staff about any allergies or reactions you have had to medicines in the past.

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Preventing medicine mistakes

What to think aboutBeing prepared and informed before going to hospital can help you feel oriented and empowered once you get there.

Here is some information, and some tips and checklists to help you manage your expectations and help you stay safe and feel more at ease in hospital.

Your rights and responsibilitiesA good starting point to help you adjust to the hospital setting and receive the best care possible is to understand your rights and your responsibilities as a patient.

One of your key rights is to know the identity and functions of the hospital personnel who are involved in providing your care during your stay (see list on page 24). Hospital staff who come into your room should introduce themselves and explain why they are there. If they don’t, you can ask them.

Good communication is important when you are in hospital. You have the right to ask questions to help you understand your treatment, any tests you have, and how your recovery is progressing.

On the other hand, it is your responsibility to provide accurate and complete information about your health and to speak up if you are not clear about anything or why something is being done.

Managing your individual needsHere is a checklist of things to tell hospital staff to make sure they take care of any requirements you may have. Sometimes you can note these on your admission paperwork. You can also talk to the staff on your ward about these issues. Tick the ones that are relevant for you.

Special dietary requirements (e.g. if you are vegetarian, have diabetes, or need gluten-free, halal, or kosher foods)

Interpreter services

Any religious or cultural requirements

Other special needs (e.g. if you have reduced mobility, or vision or hearing impairment)

Thinking ahead to after you leave hospitalPlanning in advance for your return home from hospital can help you feel supported throughout your recovery process. Here is a checklist of things you could plan for, prior to your admission, to help you make a smooth transition home.

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During your stay

In the hospital there is a team of different people you may meet at different times during your stay. You may meet the following people.

Who About

Anaesthetist • Evaluates you before an operation.• Forms a plan for your medical care during and after the anaesthetic,

focusing on pain management and your safety• Gives you the anaesthetic• Monitors and supports you during the procedure

Chaplain • A chaplain provides pastoral care (emotional and spiritual support) to patients and their families

Dietitian • Helps you manage your nutrition in hospital as well as any dietary requirements you may have

Discharge Planner or Case Manager

• Can help ensure you have a smooth move home from hospital• Can help ensure you have access to appropriate community-based

support services

Nurse • Monitors your health and administers your medicines• Looks after your needs and helps keep you safe and comfortable

OccupationalTherapist

• May conduct a home visit• Can help you with ways to manage around your home

(e.g. how to shower and dress yourself after surgery)• May prescribe or provide you with specialised equipment

Pharmacist • Dispenses your medicines and works with doctors and nurses to ensure the best choice of medicine, the right dose and length of treatment

Physiotherapist • Helps you with exercises to strengthen your muscles and joints to get you moving after your procedure if needed

Social Worker • Can help you with any information and counselling that you may need• Can help plan your discharge from hospital including referrals to any

community services you may be eligible for

Surgeon/Specialist • A doctor* who has advanced knowledge and training in a specific area of medicine

Ward Clerk • Helps manage the ward

• Can help you get oriented to the ward

• Provides any necessary paperwork

* Your surgeon and specialist can be the same person. Sometimes another specialist, such as specialist rehabilitation physician, may also be consulted.24

People you may meet

Preparing for your treatment or surgery Informed consent

The clinical consent form (for your consent to the procedure itself) comes with the hospital’s Admission Information pack.

Clinical informed consent means that you have been given accurate information in a way you understand so you can make the decision about having the procedure that is right for you.

Make sure you:• Understand what treatment

or surgery you are having, and why you are having it.

• Understand all your options, including what happens if you don’t have the procedure.

• Ask any questions you have so that you understand the risks and potential complications and what will be done to prevent these.

You may withdraw your clinical informed consent at any time during your hospital stay.

When you have been admitted, you will see many different hospital staff who will help you.

Your preparation may involve:• Fasting for a few hours ahead

of the procedure.

• Confirming your identity.

• Getting and/or checking your identification arm band.

• Changing into a hospital gown.

• Putting on compression stockings.

• Being weighed, and having your temperature, pulse and blood pressure taken.

• Reviewing your medical history including past and present health conditions and what medicines you are taking.

• Having some body hair removed or your skin marked.

• Showering if you have not already done so.

• Meeting your anaesthetist who will do an assessment to confirm you are fit for surgery.

• A visit from your surgeon.

• Completing your clinical consent form.

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Some people may feel nervous or anxious when they are admitted into hospital, especially before and after treatment or surgery.

Tips for managing anxietyThings you can try to help manage anxiety before a procedure include:

• Being informed: Find out as much as you’re comfortable knowing about the treatment or surgery you will be having and your hospital stay. Talk to your doctor for further advice.

• Getting support: Talk to family, friends, or health professionals about your feelings.

• Distracting yourself: Try activities like reading or watching TV to distract yourself from anxious thoughts.

• Writing it out: Make a list of things you are worried about then write a plan for what you could do about them (e.g. asking your doctor about pain relief at home).

• Relaxing: Try relaxation exercises like slow breathing or progressive muscle relaxation.

• Listening to music: Your favourite music may help you relax and feel calmer.

If you are finding it hard to manage your anxiety, talk to your doctor.

Managing nerves

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Waking upAfter your procedure, especially if you have had an anaesthetic, you will be in the recovery room. If you’ve had surgery, you will have a bandage or dressing over the site that was operated on. Your pulse, blood pressure, and breathing will be monitored for a few hours to make sure they are stable, until you can be moved to your ward.

You may also still have an intravenous line (IV) for fluids, an epidural line (if you have one), drains from the wound, a urine catheter, and your dressings if appropriate.

You may have a sore throat if you’ve had a general anaesthetic. You may also need pain relief to help with any discomfort after the procedure as the anaesthetic wears off, as well as medicines to help manage any nausea and vomiting.

Pain reliefIf you require pain relief it can be given to you in the following ways:

• By patient controlled analgesia (PCA): this is a device that allows you to control your own pain relief. When you feel pain, you can push a button that delivers a dose of medication to relieve the pain through an IV line into your body. The machine is programmed so you can’t give yourself too much. Once you are eating through your mouth you can be switched over to getting pain relief medicines orally.

• By epidural: pain relief medication is given through a tube placed in the space around the spinal cord, known as the epidural space. This may remain in place until you can be switched over to oral pain relief medication. Tell the nurse if you feel any numbness or tingling in your arms or mouth.

• By mouth (orally): once you are eating and drinking well, you will get pain relief medication to take by mouth if required.

If you continue to be in pain once you have been administered pain relief medication, tell your doctor or nurses.

What to expect after your treatment or surgery

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Preventing blood clotsYou may need to have medication to help prevent blood clots after some procedures (e.g. hip and knee replacement surgery).

Many surgical procedures increase the risk of blood clots forming, particularly in the legs. These blood clots can break off and travel into the lungs which can cause a blockage known as a pulmonary embolism.

Medicines to help prevent blood clots (called anticoagulants) can be given as an injection under the skin or as a tablet. You may also be given compression stockings or a device that squeezes the muscles of the legs intermittently (intermittent pneumatic compression).

You may need to take an anticlotting medicine for a month or so after some types of surgery. Talk to your doctor if you have any questions about this.

Preventing infectionDepending on the procedure you have had, you may be given antibiotics to help prevent infection. Your doctor will decide if you need to continue to take antibiotics after you are discharged.

The following tips can help you reduce your risk of infection after your procedure:

• Follow instructions from your doctor and/or nurses on how to look after your wound.

• Wash your hands with soap and warm water and dry them thoroughly, particularly after using the bathroom, and ask your family and other visitors to wash theirs.

• Make use of the alcohol-based hand rubs which are conveniently located throughout most hospitals.

Getting up and movingIt’s important that you are able to move around safely in hospital (e.g. getting in and out of your bed or a chair and going up and down stairs).

If you need physiotherapy, for example after hip or knee replacement surgery, a physiotherapist will usually visit you each day after your surgery to take you through exercises that are designed to help your recovery.

Soon after surgery, depending on your progress, you may be able to sit on the edge of the bed, stand, and even walk with help.

You will need to use walking aids until your doctor or physiotherapist confirms you’re ready to walk unassisted. Check with your doctor and physiotherapist how long they expect it will be until you reach this milestone.

An occupational therapist may come around a few days after your procedure to assess how well you can take care of your personal hygiene, as well as how well you can get dressed.

Preventing fallsTo help reduce the chance of falls while you are in hospital (and when you get home), make sure you:

• Take your time when you are getting up.

• Take extra care if you feel unsteady on your feet.

• Ask for help if you feel dizzy, light-headed, or unwell.

• Familiarise yourself with the ward or your surroundings and keep important things within reach, including your nurse call button.

• Ask for help if you need it when getting to the bathroom or toilet.

• At night, turn on the light before you get out of bed, and when you are in the toilet.

• Use a walking aid (if a physiotherapist has given you one), use handrails in the bathroom and hallways. In hospital, don’t use unstable items like your IV pole or tray table for support.

• Wear your glasses and/or hearing aids if you need them.

• Beware of trip hazards (e.g. anything on the floor such as mats, papers, spills or even your own clothing if it is too long or loose).

If you are at risk of falls, you may be supplied with a pair of grip socks to wear.

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Sleep is important for your overall health and wellbeing. While it’s important to get a good night’s sleep, sometimes this can be hard during a hospital stay for many reasons, such as:

• The lighting in your room is not right — it may be too dark during the day or too bright at night.

• There are disturbances at night by hospital staff (e.g. to take your blood pressure or give you medicines), or noises from other patients.

• You are in pain or feel nauseous following your surgery.

However, there are some simple things you can try to help you get a better night’s sleep in hospital:

• Make sure the curtains or blinds are open during the day and closed at night.

• Do your prescribed post-operative exercises (if appropriate) and get some time out of your room when you can.

• Take advantage of your hospital’s rest period but try not to nap too much during the day.

• If you do nap, try to make sure your nap lasts no longer than 30 minutes at a time.

• Avoid coffee or other foods and drinks containing caffeine (e.g. tea, chocolate) close to your bedtime.

• Finish eating 2-3 hours before you plan to go to sleep.

• Try a relaxation activity, reading, or listening to music before going to bed.

• Try wearing an eye mask or ear plugs.

• Take your pain medicines as directed and tell the hospital staff if you are still in pain.

• If you are worried about something, and this is affecting your sleep, talk to someone about your concerns. You could make a list of things you are worried about then write a plan for what you think could do about them.

• Ask for help with your bedding to make you more comfortable, and to ensure that you are not too hot or too cold.

If you are having trouble sleeping, talk to your doctor or a nurse.

Getting a good night’s sleep in hospital

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How long you stay in hospital depends on the treatment or surgery you have had, how quickly you recover, and whether you develop any complications.

After your hospital stay, you may need rehabilitation care in a specialised facility, particularly if you have any physical problems following your operation, and you require considerable nursing care. Otherwise, you will be able to go home when you are discharged.

Your doctor will probably let you know before the procedure if you are likely to require rehabilitation. As a Bupa member, rehabilitation at home may also be an option for you if you require additional clinical support and you have a referral from your doctor or hospital.

For more details about what is included in your level of cover, please contact us on 134 135.

Discharge from hospital

On the day you leave hospital there are many things to take care of. Here are some checklists to help you.

Things to make sure you have before leaving hospital

Any paperwork you need for discharge (e.g. a ‘discharge summary’).

Any letters or information for your GP — sometimes these are mailed separately by your surgeon or the hospital.

Any prescriptions or a supply of medicines you need — or a list of medicines or repeats you need to obtain from your GP and pharmacist. Call us on 134 135 to check the details of your level of pharmacy cover.

Written instructions for managing your medicines (see Managing your medicines information below).

Written instructions for any exercises you need to do (if applicable).

Written instructions for looking after your wound (if you have one).

Things to make sure you understand before leaving hospital

Whether you need and can get any services to help you at home — a social worker, occupational therapist, nurse, or discharge planner/case manager can help you access any services you may need.

When you will have a follow up appointment with your specialist.

When to call the doctor e.g. if there are any complications. (See What to watch out for on page 34).

Preparing to go home

Q: How long is my recovery likely to take and what are the key milestones?

A:

Q: What level and kind of physical activity can I do after my surgery?

A:

Q: What ‘dos and don’ts’ can I follow to help me recover well?

A:

Q: Will I need further care services at home?

A:

Q: When can I return to work?

A:

Q: When will I be able to drive?

A:

Q: Are there any long-term physical limitations I may need to be aware of?

A:

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Depending on the procedure you have had, it may take several months to fully recover and be as independent as you were before.

Asking your healthcare team the following questions can help you set your expectations and work out how to best approach your ongoing recovery.

Questions to ask about your recovery

Before leaving hospital, don’t be afraid to ask any questions you may have about your medicines.

Make sure you know how to manage them when you return home. The hospital staff are there to help you so don’t hesitate to ask them.

Here are some questions to ask:

• Find out what new medicines you will need to take when you go home and why you need to take them.

• Make sure you understand how to take each new medicine and how long you will need to take it for.

• Ask if you should continue taking all your previous medicines and if there are any you need to stop.

• Ask if you will need to get further supplies of any new medicines (you will usually be given only a limited amount by the hospital pharmacy).

• Ask if you will be given prescriptions for any new medicines.

• Ask about any side effects that you may experience and how they can be managed.

• Ask if any changes made to your usual medications have been sent to your GP.

Managing your medicines

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After your stayRecovering at homeOnce you are home from hospital it’s important to look after yourself. Here’s where the planning you did before going to hospital will be important.

Here are some things to think about to help you keep on top of things at home:

MedicinesTake your medicines as directed and contact your doctor if you have any problems. Arrange for family or friends to get your medicines from the pharmacy for you if necessary. Consider using a dosing aid to help you keep track of your daily medicines. A medicines list or an app like MedAdvisor can help you keep all the information about your medicines together. You can ask your pharmacist and/or doctor for assistance.

My plan:

ExercisesMake sure you know what exercises you need to do, if appropriate, and how to do them safely. Get written instructions from the hospital or physiotherapist if possible.

My plan:

Preventing fallsContinue to take extra precautions as you are moving about your home to reduce your risk of falling. See page 28 for some tips.

My plan:

NutritionMake sure to eat balanced meals as good nutrition is important for recovery. Activate your plan for preparing meals and shopping. Ask for help if you need to.

My plan:

SleepSleep problems may happen after you return home. See page 29 for some things to try for a better night’s sleep. If sleep disturbance persists, see your doctor.

My plan:

In the first 24 hours after leaving hospital do not:

• Operate dangerous machinery or tools

• Sign legal documents

• Drink alcohol

• Drive

This is very much aligned to surgical patients that have been administered anaethetics 24 hours prior. This may not be relevant for general hospital admissions.

Contact your doctor if you:

Have a fever (i.e. a temperature of 38.5°C or higher).

Have any bleeding.

Have pain that is not controlled by your pain relief medications.

Your wound has redness, pain, swelling, or yellowish discharge.

Have swelling in one of your legs or pain in your calf muscle.

Are not managing tasks of daily life such as dressing, showering, or preparing meals.

Have ongoing sleep problems.

You are feeling down and it is not getting better or have any other concerns.

Prepare for any post-op bluesAfter an operation, some people can feel quite down. This can be a reaction to the general anaesthetic, pain and discomfort, lack of mobility, and increased dependency on others. In most cases, the blues will lift as you recover and resume normal activities.

Here are a few tips to help manage your mood as you recover from surgery:

• Ask your family and friends for support.

• Go outside for some time every day.

• Listen to music, play games, read, watch movies.

• Try not to nap too much during the day so you can get a good night’s sleep.

• Resume your daily routines, hobbies, and activities as soon as you are able.

• See your doctor if symptoms of depression (see box below) last for a couple of weeks or start to impact your everyday life.

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What to watch out for

Some of the symptoms of depression can include:

• Persistent low mood and sadness.

• Low self-esteem.

• Not enjoying things you used to enjoy.

• Difficulty sleeping, unrelated to physical discomfort.

• Extreme tiredness.

• Irritability, frustration.

• Difficulty coping.

• Loss of appetite, or eating more than usual.

• Feeling sick and run down.

Your coverPrivate health insurance can contribute towards hospital and medical costs so you can focus more of your energy on your recovery. But it doesn’t necessarily pay for all the costs associated with a hospital admission.

In this section, we aim to help you understand what may and may not be covered and suggest ways for you to make the most of your cover.

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Hospital costs — what’s covered?For services included in your policy, when you’re admitted to hospital as a private patient, you’re covered by Bupa for the hospital’s service charges, which typically include:

• Accommodation for overnight or same-day stays.

• Operating theatre and intensive care fees (as applicable).

• Any medicines approved by the Pharmaceutical Benefits Scheme (PBS) supplied to you as part of your in-hospital treatment.

• Physiotherapy and other allied health services, including occupational therapy and dietetics.

• Surgically implanted prostheses up to the approved benefit in the Government’s Prostheses List. To avoid any out-of-pocket costs, we suggest discussing prosthesis choices with your specialist before going to hospital.

Medical costs — what’s covered?These are the fees charged by specialists involved in your hospital treatment (e.g. surgeon, anaesthetist).

Medical costs also include pathology and radiology diagnostic tests recognised by Medicare, performed in hospital by Bupa recognised providers.

As a private patient, you’re covered for the cost of medical treatment up to the Medicare Benefits Schedule (MBS) fee (see box below). Medicare pays 75 percent of the MBS fee and Bupa pays the remaining 25 percent. If your specialist charges more than the MBS fee, there will be an out-of-pocket cost (often known as a ‘gap’) for you to pay.

However, if your specialist uses this, Bupa’s Medical Gap Scheme can help eliminate or reduce the gap for you.

See page 42 for more details.

When you’re admitted to hospital, the services you receive are separated into two different categories — hospital and medical. It’s important to understand the difference between the two, as they are charged differently.

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Hospital versus medical costs

What is the Medicare Benefits Schedule (MBS)?The Medicare Benefits Schedule (MBS) is a list of medical services (e.g. specialist consultations, procedures, and tests) subsidised by the Australian Government. The Government sets a fee for each service to determine the benefit you can get back from Medicare. It does not cover things such as private patient hospital costs (e.g. theatre fees and accommodation), or the cost of prostheses. Your hospital policy will contribute to the cost of these services.

Exclusions and restricted coverSometimes specific services or treatments may be excluded under your level of cover. In these cases, you’ll be responsible for all expenses related to your hospital admission for that procedure or service.

If you only have ‘restricted cover’ for a service, the amount Bupa pays for your hospital accommodation is the minimum shared room benefit as set by the Australian Government. This means that, in most cases, you’ll be covered for treatment in a public hospital. However, in a private hospital as a private patient, you’re likely to have large out-of-pocket expenses for your hospital stay.

If a treatment or service is excluded or restricted on your cover, you should contact Bupa as there will be significant out-of-pocket costs, even when you have ‘restricted cover’. If you wish to be covered for the affected services or treatment, you will need to upgrade your cover. A 12-month pre-existing condition waiting period applies to services with a higher level of cover.

For more information, please see the Important Information Guide, available at

bupa.com.au/retail-info for domestic and corporate covers, or

bupa.com.au/visitors-info for overseas visitors, or

bupa.com.au/oshc-info for overseas students.

Excess and co-paymentsDepending on your level of cover, you may need to pay an excess and/or co-payment for your hospital admission. Check with Bupa or the hospital to see what excess and/or co-payment (if any) will apply to your hospital stay.

Fixed feesThis is a daily charge billed by a small number of Members First and Network hospitals (see page 40) that you’re responsible for paying. The hospital should inform you of any fee when you make a booking. Fixed fees allow Bupa to bring you a greater range of hospitals that provide certainty around your costs. If you have Ultimate Health cover, you’re reimbursed for any fixed fee.

While your hospital cover helps pay for a wide range of services as a private patient you may receive, there are occasions when you won’t be fully covered and may have out-of-pocket costs to pay. For example:

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Costs you might not be covered for

Ambulance serviceIn most circumstances, Bupa will cover you for emergency ambulance transport and on-the-spot treatment by our recognised providers in the state where your admission occurs. These services are usually capped at one service per calendar year for single memberships and two services a year for family and single parent memberships. If you can claim the ambulance service from another source such as compensation, or a third party subscription, you won’t be covered for emergency ambulance transport under your policy.

Non-emergency medical transport won’t be covered, including:• Transport from a hospital to your

home, a nursing home, or another hospital where you’ve been admitted to the transferring (first) hospital; and

• Transport from your home, a nursing home, or a hospital for ongoing medical treatment.

Premium Ambulance Cover can be purchased on its own, or in addition to your existing hospital cover. Call Bupa on 134 135 for more information.

There are different state ambulance arrangements across Australia. See page 8 for more details.

Outpatient servicesExcept for a limited range of programs, your hospital cover only applies when you’re admitted to hospital as an ‘inpatient’. Your hospital can tell you if you’re covered for a specified outpatient program but if you’re unsure, contact us.

When leaving hospitalYou may need to pay for certain services or products when you are discharged from hospital. Depending on your level of cover and the hospital you attend, these may include:

• Pharmacy items not opened at the point of leaving hospital or provided to you upon discharge (though a benefit may be payable by Bupa depending upon the item and your level of cover).

• Incidental fees for things like movies and non-local phone calls.

• Provider or patient requested non-emergency ambulance transportation.

• Other services not included as part of your cover.

Where you receive benefits from another sourceYour health insurance doesn’t apply where compensation, damages or benefits may be claimed from another source in relation to a condition, injury, or ailment (e.g. workers’ compensation).

As a nursing home type patientIf you’re assessed during your hospital stay as no longer needing acute care and in hospital for more than 35 days, you’ll be classed as a nursing home type patient. In this case, Bupa will pay benefits that are much lower than normal hospital benefits and you’ll be required to make a personal contribution towards the cost of your care.

Where Medicare pays no benefitThere are certain hospital procedures that are not eligible for a Medicare rebate and which are not covered by your hospital cover. If your surgeon advises that Medicare does not recognise your procedure, contact Bupa for further information.

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Need more information or advice? Talk to our friendly staff.

134 135

bupa.com.au

Visit a Bupa store

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Talk to your specialistIf your doctors’ fees include any out-of-pocket charges, your specialist or treating doctor(s) must let you know the cost and get your agreement (informed financial consent – see page 41) before your admission to hospital.

Ask your doctor for the Medicare Benefits Schedule (MBS) item number(s) they will be using as Bupa will need these to give you an accurate quote. Your specialist should also provide advice on fees charged not only by themselves but also by other specialists or surgeons as well as by anaesthetists, assistant surgeons, pathologists, and radiologists.

You may have lower or no out-of-pocket medical costs if your treating doctor(s) elect to use Bupa’s Medical Gap Scheme (refer to page 42 for more information).

Other questions for your specialist to help you get clear on costs

• Can you provide me with a written estimate?

• Can you provide me with a ‘no gap’ experience?

• How long do you think I’ll be in hospital?

• Does my treatment involve a prosthesis/implant (e.g. knee replacement) and, if so, will I incur an out-of-pocket cost?

Talk to BupaTo get the most from your cover, like avoiding unexpected out-of-pocket costs and confusion, call Bupa before your admission. You may want to ask us the following questions:

• Am I covered for my treatment?

• What do I need to know about hospital and medical costs?

• Are there any waiting periods, exclusions, or restricted cover? (If you are within waiting periods, you will need to ask your doctors to fill in medical certificates for Bupa to assess whether benefits will be paid. If you go ahead without confirming that you’re entitled to claim benefits, and Bupa determines you have a pre-existing condition, you will have to pay all hospital and medical charges not covered by Medicare, which can be quite significant.)

• Do I need to pay any excess or co-payments?

• Is my Private Hospital a ‘Members First’ or ‘Network’ hospital and, if so, what benefits are available to me as a Bupa member? (See page 43 for more information about Members First and Network Hospitals).

Talk to your hospitalPrior to your admission, the hospital staff will perform a membership eligibility check. The hospital will advise if your admission involves any out-of-pocket charges. They will let you know the cost and get your consent in writing by asking you to sign an Informed Financial Consent (IFC) form before or on admission.

To get prepared financially for your stay in hospital, here’s what we suggest you do prior to admission.

Preparing financially for your stay

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What is informed financial consent?Before you receive any treatment you are entitled to ask your doctor, your health insurer, and your hospital about how much your treatment will cost, including any extra money you may have to pay out of your own pocket, commonly known as a ‘gap’ payment. Informed financial consent must be confirmed in writing so it’s clear that you have received and understood this information and agreed to it.

You should get agreement from your specialist before you book your first appointment that they will use the Bupa Medical Gap Scheme and, if so, what gap arrangement they will apply.

Remember, health insurance can only cover you for costs while you are admitted to a hospital. Any costs while you’re not admitted to hospital can’t be covered — Medicare will pay a certain amount and you’ll need to pay for the remainder yourself.

What is Bupa’s Medical Gap Scheme?If your specialist’s fee is more than the MBS fee plus the additional amount Bupa pays for you, you’ll need to pay the remainder yourself, known as the ‘gap’ payment. The Bupa Medical Gap Scheme is an arrangement Bupa has with some private specialists to help eliminate or reduce such out-of-pocket expenses for your hospitalisation. Bupa provides two different arrangements — either ‘no gap’ or a ‘known gap’.

No GapIf your specialist has registered to use the Bupa Medical Gap Scheme with no gap, they will bill Bupa directly and you won’t have to pay anything for your specialist’s services in hospital. This is the best value option for you.

Known GapIf your specialist has registered to use the Bupa Medical Gap Scheme with a known gap, they are permitted to charge you a gap up to a maximum of $500 for services provided in hospital.

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Your doctor(s) can choose to use the Bupa Medical Gap Scheme for your admission in:• A Public Hospital, or;

• A Private Hospital with which Bupa has an agreement. This applies to each doctor involved in your treatment.

What can I expect if each doctor involved in my treatment chooses to use Bupa the Medical Gap Scheme:In a Public Hospital:• If you have a pre-booked admission, you may be charged up to a limit of $500

for your treatment by that doctor while you are in that hospital.

• If you are admitted any other way such as through the Emergency Department, your doctor will bill Bupa directly and you will pay nothing while you’re in that hospital.

In a Private Hospital with which Bupa has an agreement:• You’ll never have to pay more than $500 for medical treatment per doctor

– we may even pay for the full cost while you’re in that hospital.

Find out more at: bupa.com.au/medicalgapscheme

Bupa membership can give you access to a range of member benefits when using our national network of hospitals.

Members First HospitalsIf you attend a Members First hospital, in most instances you’ll be fully covered for your hospital expenses, such as accommodation, operating theatre, and intensive care fees (if applicable) with the added benefit of a private room or $50 back (paid by the hospital) for overnight admissions except for particular circumstances, for example if:

• Your hospital visit isn’t booked at least 24 hours before admission.

• You become a nursing home-type patient (i.e. you stay in hospital more than 35 days without an Acute Care Certificate).

• You are admitted via an Accident and Emergency Department.

• You are a day patient (including if your stay leads to an unplanned overnight stay).

• Where it is clinically inappropriate.

• You don’t request a private room at time of booking.

You’ll also have access to other benefits such as a daily newspaper, local phone calls and Free to Air TV at no additional cost.

Travel and accommodation benefitWe can now help cover the costs of your travel and accommodation expenses, if you need to travel 200km or more for medically essential treatment not available in your local area. The benefit is per person, per trip (limits apply), and can be used as many times as needed throughout the year. If you have an extras cover with us, we’ll only pay the travel and accommodation benefit on your hospital cover. See your policy information for more details.

Network HospitalsIf you attend a Network hospital, in most instances, so long as the service is included in your selected hospital cover, you’ll be fully covered for your hospital expenses, such as accommodation, theatre, and intensive care fees. At a Network hospital, you’ll also have access to local phone calls, where available, pay TV and Free to Air TV at no additional cost. But don’t forget that a small number of Network Hospitals may charge a daily fixed fee.

Family In-hospital benefitIf you’re on a cover that provides Family In-Hospital Benefit, you could receive benefits for accommodation and meal costs if your partner, immediate family member, carer or next-of-kin is required to stay at hospital with you or a person on your membership. They will be covered for $60 per night for accommodation in hospital and up to $30 a day for hospital meals. Hospital meals are covered when ordered from the patient meal menu.

Ultimate gap bonusThis is only available on Ultimate Health Cover - Gold and Ultimate Corporate Health Cover - Gold.

Receive a $200 bonus when you join Bupa and every calendar year thereafter. This can be used towards a doctor or specialist’s out-of-pocket costs (whilst in hospital) and any unused bonus amounts will accumulate each year.

Bupa – bringing you greater value and certainty

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Your hospital costsAll Members First and Network hospitals will ask you to complete claim forms on admission, which they will submit directly to Bupa on your behalf. The hospital would have asked you to pay any excess, co-payment, or fixed fee upon your admission.

Your hospital’s Admission Information booklet also states that, in the event that additional services are required and costs incurred (e.g. an amount not covered by Bupa) the hospital will raise an account which is to be paid when you leave hospital, also known as being discharged.

Your medical costsIf your specialist doesn’t use Bupa’s Medical Gap Scheme, you’ll need to complete a Medicare ‘two-way claim form’ for all your medical costs. The form is available at any Medicare or Bupa store. Medicare will process your claim and pay you the benefit, and liaise with Bupa to pay a portion of the bill. If you can’t visit a Medicare office during your recovery, contact either Bupa or Medicare and ask for the relevant forms to be sent to you.

Statement of BenefitsAfter your hospital and medical (from doctors and specialists) claims have been processed, Bupa will send you statements showing what has been paid on your behalf. Please check that these details are correct and contact Bupa straight away if you have any queries. Your medical statement may include costs charged by specialists you may not have seen directly such as pathologists.

Medicare and Pharmaceutical Benefits Scheme (PBS) Safety NetsThe Government’s Medicare Safety Net provides financial assistance to people with high out-of-pocket costs for outpatient services that pay a Medicare benefit. Once you reach a threshold, you may be eligible for additional Medicare benefits for the rest of the calendar year. The PBS Safety Net is also available to those who need a lot of medicines on the PBS each year.

For more information, visit humanservices.gov.au

How to claimThe following information will help you work through the claims process so you can return home without the worry of extra paperwork and unexpected bills.

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Looking after your health and wellbeing and understanding your cover are important for helping you have a successful procedure and recovery.

We hope this guide has helped you better understand the experience of going to hospital. Remember… If you feel overwhelmed or need more information, please call us on 134 135, or visit bupa.com.au.

We’re here to support you as you navigate your way into and out of the hospital system. Find out how you could also benefit from your Extras cover and our broader health and wellness programs during your recovery.

Other resources you may find useful include:• Australian Government’s

Private Patients’ Hospital Charter health.gov.au

• Bupa Members First and Network Hospital listing bupa.com.au/find-a-provider

• Bupa’s health information bupa.com.au/healthlink

• Bupa's member support programs bupa.com.au/member-support

We’re here to help

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© Bupa HI Pty Ltd July 2019. This information has been devel-oped and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice. We makes no warranties or representations regarding the completeness or accuracy of the information. Bupa HI Pty Ltd is not liable for any loss or damage you suffer arising out of the use of or reliance on the information, except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health.

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SourcesHip or knee replacement what to ask your doctor beforehandU.S. National Library of Medicine. MedlinePlus. nlm.nih.gov

Improving your sleep during your hospital stayMemorial Sloan Kettering Cancer Center. mskcc.org/cancer-care/patient-education

So you’re going into hospitalThe Society of Hospital Pharmacists of Australia (SHPA), Pharmaceutical Society of Australia (PSA), and Department of Veterans’ Affairs (DVA) shpa.org.au

Managing your medicinesNPS MedicineWise nps.org.au

Anxiety disorders [Online]The Australian Psychological Society (APS) psychology.org.au

What can help relieve anxiety before surgery?informedhealth.org

Bupa PO Box 14639

Melbourne VIC 3001

Bupa HI Pty Ltd ABN 81 000 057 590

Effective 1 July 2019 11884-07-19

For more information134 135

bupa.com.au

Visit a Bupa store