Information for medical professionals on hospital admission and discharge.
Under our hospital arrangements, we will cover necessary treatment in a:
- public hospital
- contracted private hospital
- contracted private hospital for mental health services
- contracted day procedure centre
You must contact us for approval before referring a patient for treatment in a:
- non-contracted private hospital
- non-contracted private hospital for mental health services
- non-contracted day procedure centre
Before you admit a patient to a non-contracted facility you must apply for prior financial approval.
Our contracted hospitals
Please see our Delivering hospital based care page for
- a list of our contracted hospitals
- information on our hospital based programs
Patients are eligible to receive health care under our hospital arrangements if they hold:
Generally, people who have Veteran Gold Cards can access all health care services and treatment listed on the Medicare Benefits Schedule (MBS).
For patients with a Veteran White Card, we may pay for hospital treatment for:
- an accepted condition
- malignant cancer (neoplasia)
- pulmonary tuberculosis
- any mental health condition
For more information read about Cover for cancer and tuberculosis care and Cover for mental health care.
If your patient is a Commonwealth or allied veteran, please see our Commonwealth and other allied veterans page for eligibility and treatment information.
We may not pay for:
- a program that has not been approved by us or is not contracted with us
- treatment that is not on the Medicare Benefits Schedule (MBS)
- a procedure for cosmetic purposes
- devices not listed on the Prosthesis List
Check your patient's eligibility
If you need to check a patients eligibility or are unsure if we will pay you can:
We will provide written confirmation if Prior Financial Approval requests are approved.
If your patient has a written authorisation for treatment, we will only pay for the treatment listed in the authorisation.
Our clients may have documents from us confirming their accepted conditions. Accepted conditions are also available to our clients on their MyService accounts.
Our clients may present their conditions from MyService on their mobile phone.
If your patient needs to be admitted to hospital in an emergency, they can be admitted to either:
- the nearest public hospital where they can be treated as a private patient
- the nearest private hospital with an emergency department
Doctors with admitting rights can admit the patient to a contracted private hospital for treatment.
If a non contracted hospital is the closest facility available the patient should only be admitted to the emergency department.
If possible, confirm your patient’s treatment entitlements before arranging admission to a non-contracted hospital.
If this is not possible, obtain our approval on the next working day after admission by:
If a client chooses to be treated under their private health insurance we are unable to pay for their hospital treatment.
This includes any out of pocket expenses that they may incur, such as:
- costs for any intensive care
- rehabilitation services
- any remaining gap costs
As these costs could be expensive you should discuss this with your patient before they make a decision.
Our clients can contact us to discuss the use of private health insurance.
If you are a General Practitioner you are the most appropriate post-discharge care coordinator for your patient. Your role includes:
- receiving and acting on advice from hospital discharge planning staff about your patient’s needs
- ensuring continuity of care after discharge from hospital
- coordinating the medical care of your patient following their discharge from hospital
Clients should be treated at the nearest local hospital or facility. We may not pay travel assistance for country patients who are admitted to metropolitan facilities where local care is available.
If you are unsure if we will pay for travel please contact us on 1800 550 455.
You can find out how to organise transport for our clients on our Travel for a client's treatment page.