In shortMedicare doesn't pay a benefit if a hospital medical service doesn't meet its rules, and when this happens, Police Health doesn't pay either. |
On this page
- Why Medicare doesn't pay a benefit
- Why doesn't private health pay if Medicare doesn't pay a benefit?
- Common examples of Medicare not paying a benefit
- How to find out if Medicare will pay
Why Medicare doesn't pay a benefit
Medicare won't pay a benefit if a Hospital medical service doesn't meet its rules. This can happen for different reasons, including any of the following;
- It isn't listed on the Medicare Benefits Schedule (MBS)
- It doesn't meet Medicare's clinical eligibility criteria
- It’s performed purely for cosmetic reasons
Why doesn't private health pay if Medicare doesn't pay a benefit?
If Medicare doesn’t pay a benefit for your Hospital medical service, private health insurers like Police Health doesn't pay a benefit either*.
Common examples of Medicare not paying a benefit
There are 3 common examples of Medicare not paying a benefit, including (but not limited to);
- Cosmetic procedures that are purely for cosmetic reasons
- Services that don't meet the MBS clinical criteria
- Services not listed on the MBS
These are examples only, and if you require more clarification please call us on 1800 603 603.
How to find out if Medicare pays for your Hospital medical service
The best thing you can do is ask your treating doctor, specialist or health professional before going to Hospital;
- Does Medicare pay a benefit?
- Will my private health pay for this?
- Will I have to pay anything?
You should be given an itemised quote, so you know if Medicare or private health will help, or if you'll have to pay.
If you're still not sure, call us on 1800 603 603 or email enquiries@policehealth.com.au and have the quote with you.
*All benefits may be subject to Waiting Periods, Limits and other conditions. Review the cover tables on the Combined, Hospital and Extras pages, and your State Premium and Benefit Guide or contact us for more information.