This fact sheet provides you with information on your choices during your stay in hospital.

Last updated: 16 February 2018

If you have a Medicare card you can generally choose to be treated as a public or a private patient, this is called an election. Section A provides you with some information on the differences between being a public and a private patient during your stay.

If you are in hospital because you were involved in a motor accident or a workplace injury, or if you have a Department of Veterans’ Affairs card (see section B), please discuss this with our friendly staff.

This leaflet also provides information on other patient types in sections B & C including:

  • members of the Australian Defence Force
  • overseas patients
  • Nursing Home Type patients

How to make an election

All patients in our hospital need to complete an Inpatient Admission Election Form.

Before you complete the form, please ensure you, or your representative understands your choices available to you. Most information is contained in this leaflet and our staff can assist with any other questions you have. We can also arrange an interpreter if you need help with understanding your choices or filling in the election form.

Once an election is made, it can only be changed in the event of unforeseen circumstances, such as:

  • you are admitted for a particular procedure and develop complications which need additional procedures
  • your hospital stay is substantially longer than originally planned by the clinical staff treating you
  • your social circumstances change while you are in hospital, for example job loss.

Where a valid election is changed, this will be effective from the day the change is made.

What happens if a patient is unable to make an election?

If a patient is clinically unable to make an informed election, an election may be made by a legally authorised representative of the patient or otherwise deferred until the patient is able to complete the process.

A legally authorised representative can be someone who:

  • is a legally appointed guardian
  • is a parent, for patients under 18 years
  • has power of attorney (authorised under the Power of Attorney Act, 1998)

Patients will receive treatment as a public patient until an election is made. When an election is made, that election will be considered to be for the whole episode of care, commencing from admission.

Your choices

Private patient – using your health insurance

As a private patient you will have the following benefits:

Specialist care

If you need a planned or booked procedure, you may choose the Specialist Doctor who will treat and care for you during your stay.

If you are admitted via the emergency department you will initially be under the care of the on-call Specialist Doctor best suited for your condition. You may choose to be transferred to the care of the Doctor who has previously treated you for the same condition.

Follow-up care

After you leave the hospital your Specialist Doctor usually provides follow-up care in their private room.

As a private patient you may also be eligible to transfer to a private hospital for further treatment or for follow-up care.

Access to a single room

You will have access to a single room in our hospital if one is available and you have single room health cover. Patients who are very ill will be given priority for a single room.

Accounts made easy

We will lodge all of your hospital accounts with Medicare and your health fund on your behalf. Once hospital accounts are paid, you will receive a patient claim statement from your health fund.

Helping your hospital

You will help our hospital if you choose to use your private health insurance. The hospital accommodation fees we receive from health funds go directly to the wards and services providing care to you.

Hospital costs

If you enter hospital through the emergency department, you will not be charged any insurance excess. If you have a planned admission, we will discuss with you if there are any fees.

You will not have any out of pocket expenses for hospital generated accounts for accommodation, prosthesis, pathology and radiology.

You will not have any out-of-pocket expenses for your Doctor(s) treating you if they charge at the level covered by Medicare and your health fund.

In an emergency admission our staff will inform you if your Doctor(s) charge out-of-pocket fees. If your hospital admission is planned your doctor should discuss their fees with you.

Public patient

If you choose to be admitted as a public patient:

  • You will be treated by doctors nominated by the hospital as you cannot choose your own doctor as a public patient.
  • You will not be charged for hospital accommodation, medical and diagnostic services, prostheses and other relevant services.
  • Once you leave hospital, your follow-up care is usually provided in an outpatient clinic of this hospital.

Self-funded private patient

If you would like to be a private patient but do not hold health insurance you can still receive all the benefits of being a private patient.

As a self-funded private patient you will be responsible for paying for accommodation, medical, prostheses, diagnostic and pathology fees.

Other patient entitlements

Workplace accident or incident

If you need treatment as a result of a work related accident or illness you may be entitled to have your health care costs paid under Worker’s Compensation insurance.

You will need to provide certain information so the hospital can send your accounts to the appropriate organisation. If you do not provide this information, the accounts will be sent to you to arrange payment from your employer’s insurance company.

If you complete an inpatient election form without indicating that you may be eligible for Workers Compensation and you become eligible, you will be reclassified as a ‘Workers Compensation patient’ and your hospital care costs will be retrospectively charged at the applicable rates.

Motor vehicle accident

If you need treatment as a result of a motor vehicle accident, your hospital claims will be managed by the hospital and the Motor Accident Authority.

You need to lodge a claim to notify your insurer of the accident details. Hospital staff can assist you if you need help to access the Motor Accident Authority (MAA) claim form.

You will also be asked to choose whether you would like to be treated as a private or a public patient in the event that your insurance claim is not accepted.

Department of Veterans’Affairs (DVA) card holders

If you hold a Gold Repatriation Health Card, you can be treated as a private patient for all conditions.

If you hold a White Repatriation Health Card, you can be treated as a private patient for conditions DVA have accepted as service related.

Hospital staff will contact DVA to confirm what hospital care you are covered for. If you are not DVA eligible for this admission you will need to make an election to be treated as a public or a private patient.

Australian Defence Force personnel

If you are a serving member of the Australian Defence Force you will be treated as a private patient in a shared room. Please ensure that you provide your Defence Force Service number (PM keys) to the hospital as soon as possible.

If you have not yet called 1800 IM SICK for approval prior to attending a public hospital please ask our staff for assistance.

Other patient categories

Nursing Home Type patients

Patients receiving non-acute care

If you are a DVA, Public or private patient and your doctor determines that you no longer need acute care; and your stay in hospital exceeds 35 days in any Australian hospital without a break of more than seven days, you will become a Nursing Home Type patient.

Nursing Home Type patients will be charged a daily fee.

The daily fee rate is calculated based on 87.5 percent of the combined standard rate of the national pension and the maximum rate of rental assistance. The hospital will provide a letter and information about these charges prior to any patient becoming a nursing home type patient.

If you receive a Centrelink Pension or Allowance, you may be eligible for rent assistance payments if you become a Nursing Home Type patient.

Overseas visitors

If you are an overseas visitor, you may receive urgent medical care in a public hospital. You will be responsible for all costs associated with your stay in hospital, including accommodation, doctor and diagnostic costs.

Hospital staff will need to take a copy of your passport. They will give you forms to fill out and information about your hospital costs and how to pay them. You will be required to provide assurance of payment.

Reciprocal health agreements exist between Australia and several other countries. You should discuss with our hospital staff whether you are entitled to receive free treatment under a reciprocal agreement.

You may be able to claim some or all of your treatment costs from your travel or health insurer.

Your privacy

If you elect to be treated as a private patient or any patient category in Section B, we will need to send certain information about you and the treatment you receive to the relevant organisation to ensure the cost of your care is covered.

We only send information in accordance with NSW Health Privacy Policy and this is explained in more detail in the Inpatient Admission Election Form. Our staff are happy to talk to you about any questions you have about the privacy of your information.

Please ask your hospital’s Patient Liaison Officer, Admission or Emergency Department Clerk if you have any questions.​

Page Updated: Friday 16 February 2018
Contact page owner: Whole of Health program