claiming on PHI, how does it all work??

[Olive]

there is a chance DD2 may need to get grommets, we have basic hospital cover..... so what does that cover the surgeon?? i assume it covers the hospital part

[feeb]

Will it be done private in a public hospital? or private in a private?

When I had boys my PHI covered my hospital stay (I had an excess to pay) and I then got sent bill for anethatist and pead which I paid and then claimed at PHI and medicare.

Dont know if that helps.

[Olive]

will be done private in private

[Spring Angel]

We ended up about $600 in total out of pocket for DS to get his tonsils and adenoids removed. Our PHI covered the entire cost of surgeon, about $400 was for the anethitist (sp?) and $200 for the room. The rest was covered by PHI.

A little boy in the room next to us had grommets was only in for day stay and was allowed home as soon as he'd eaten so didn't have to pay for the overnight stay.

This was in a private hospital in Brisbane.

HTH
Spring xx

[melbel]

It should cover the hospital costs minus any excess you may have. Plus it will cover any medical expenses up to the schedule fee....i.e. medicare pays 75% of the schedule fee and then the PHI should cover the gap up to the schedule fee....if the actual fee the surgeon or anaethetist charges is more than the schedule fee then you will have a gap to pay out of pocket.

It will also cover any drugs, dressings, meal etc whilst in the hospital.

Hope that helps

[AnyDream]

Get the surgeon and the hospital to list their charges (with the item numbers) on a quote and then contact your PHI to find out exactly how much of that they will pay.

Prepare to be unimpressed.

[Trillian]

I'm guessing the appt today went well then?

[Olive]

thanks everyone!!

trill yep ENT appointment next tuesday. she has glue ear again

[e_p]

Olive, ask your ENT if he/she will provide no gap cover - sometimes all you have to do is ask and they will charge the scheduled fee only! My PHI is with AHM and they have a list of providers who provide no-gap cover upon request/negotiation

[Olive]

ok so its happening next week, is all we have to pay on the day is the excess to the hospital?? im new to claiming on PHI

[melbel]

that should be all you need to pay on the day..any doctors gaps will be invoiced afterwards or directly billed to your PHI.....good luck hun!

[Olive]

another question.. we got the quote for the gap for the actual grommets $712, PHI will pay $492 the gap is $219 can we claim any of the gap with medicare??

ETA tis ok found out the answer

[~me~]

I know it close to EOFY, if you have had out of pocket medical expenses bove $1500 you can claim the out of pocket medical expenses after the $1500 threshold on tax. You get about 20cents in the dollar back.
Just something to consider and check with your accountant if you have one.
It may be worth checking PHI in the future with other providers as we have one where we don't pay the excess for hospital admission of children.
At EOFY request tax statements through Medicare and your PHI and your Pharmacy for scripts and keep all the receipts you have paid that don't go through the Medicare or PHI system.

HTH