A:

If you need hospital treatment, we recommend the following steps to determine your benefit and the amount of gap fees you may need to pay:

1. Contact us straight away to find out your level of hospital cover and whether you will be covered for the treatment you need.
2. Ask your doctor(s) whether they participate in the Access Gap Cover Scheme and if so, to bill your accordingly. This may help you avoid or lower your out-of-pocket expenses.
3. Check that the private hospital is contracted with ACA Health through the Australian Health Service Alliance (AHSA) by using our Hospital Search.

If your hospital stay is longer than 35 days and your doctor considers that you no longer need acute care, you will need to pay a contribution to your living costs in much the same way as nursing home type residents contribute to the cost of their care. The patient contribution is payable by public and private hospital patients and ACA Health is unable to pay benefits on this fee. Contact us for more information.