Informed Financial Consent

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Please read the following information carefully.

When you indicate your acceptance of these terms you are acknowledging and accepting the following items, which are conditions of admission. If another person (for example a spouse or family member) will be responsible for paying the account for your treatment at the hospital, that person should also read the following terms before acceptance is indicated.

(a) Actual expense incurred may differ from the estimate provided.

Whilst every effort has been made to provide an accurate estimate of the expenses you may incur, additional costs are sometimes incurred during your hospital stay. The actual expense incurred may differ from the estimate provided before your admission because, for example:

The hospital relies on information provided by your health fund which may change;

(b) You agree to pay any balance of expenses actually incurred

Your final account will reflect:

As noted on the “Estimate for hospital services” form, actual costs that are known and advised prior to your admission are payable before or on admission and any additional costs are payable on discharge.

As a condition of admission, once you have indicated your acceptance of these terms, you will be taken to have agreed to pay your final account. If you have genuine concerns, or a bona fide dispute regarding the final account (for example you did not receive a service or an item listed) you agree to raise this with the hospital as soon as possible after receiving the account and to use your best efforts to resolve any dispute at the time of discharge or within 7 days of discharge.

(c) You are required to pay the full amount or any outstanding balance if your insurer (or other payer) does not cover the cost of treatment

If the rates charged by the Hospital are higher than the reimbursement paid by your health fund / insurance company / Medicare / Workers Compensation insurer, you are responsible for paying the balance of the hospital’s rates. If for any reason health insurance benefits do not apply you must pay the charges that arise from your admission to the hospital.

(d) You are responsible for accounts from other providers

You are responsible for payment of other accounts you may receive, which may include:

If you are unsure what services you may receive during your stay and wish to know what accounts you may receive, please contact your treating doctor and the hospital before your admission to discuss this.

Payment Information

It is very important that you approach your admission to hospital well informed of the financial consequences. Please read the following information and contact your hospital if you have any concerns or queries.

Privately Insured Patients – should confirm with your health fund prior to admission the following:

Please note that if you have been a member of your health fund for less than 12 months your fund may not accept liability for the costs of this admission, e.g. if your condition or any symptoms of your condition existed prior to you joining your health fund. Any excess will be required to be paid on admission.

Repatriation (DVA) Patients – Gold card holders are covered for all care. White card holders are covered subject to approval by DVA.

Workcover Patients – total payment (aside from any ancillary charges) must be made on admission unless approval for admission has been confirmed by your insurance company.

Third Party Patients – total payment (aside from any ancillary charges) must be made on admission unless approval for admission has been confirmed by your insurance company.

Uninsured Patients – total payment (aside from any ancillary charges) must be made on admission. Please contact the hospital prior to admission for an estimate of fees and charges. As it is an estimate only, the event of unforeseen complications or variations from the proposed treatment the cost may vary.

How do I pay?

For your convenience, payment may be made by cash, EFTPOS, Bank cheques, MasterCard or Visa.

We also accept direct debit payments made to:

Westpac Albury
Albury Day Surgery
BSB#: 032 736
ACC#: 131 368

We ask that you contact us when making the payment so we can allocate it to your account and forward you a receipt.

Prosthesis

Where prosthesis (an implanted medical device) is required there will be at least one device that is fully covered by your health fund. However, based on your specific need, your doctor may recommend a device that required a gap payment by you and will explain why the gap device may provide a better health outcome. In this case we recommend you contact your doctor before admission to the hospital. As with any surgical procedure, if unforeseen circumstances should arise during the procedure it may be necessary to arrange additional medical services, or use a different or more costly prosthetic device. If this happens there may be additional costs to you that are not covered by this estimate.

What costs could I incur that will not be covered by my health fund?

Medical and allied health practitioner’s fees will be billed separately by the practitioner. Please discuss these with your doctor before your admission. You may receive separate accounts for:

If you have any further questions, please call the Albury Day Surgery on (02) 60 411 511.