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At certain times in your life, you may face health issues that require the type of attention and treatment that only a specialist doctor can provide. In these cases, you’ll be referred to one usually by your GP or another medical professional.

Sometimes you may claim a portion of these costs under Medicare. At other times, under particular conditions, your health fund may assist with these costs.

For your health fund to cover the cost of consultations with a specialist doctor, your treatment must meet specific criteria.

1. Treatment must be in-hospital

In order for your specialist doctors’ fees to be covered, your consultation or treatment must take place while you are admitted in hospital as an in-patient.

If you’re seeing a specialist doctor without being admitted to hospital (as an outpatient or just for an appointment), your health fund will not pay a benefit towards the cost, even if you see them in their rooms within the hospital. This includes obstetrician and gynaecologist consultations prior to giving birth. The good news is in most cases you can still claim a portion of these costs through Medicare.

2. You must be treated at an agreement private hospital

To have your health fund assist towards your specialist doctors’ fees during your admission to hospital, you must be admitted to an agreement private hospital. That is one that has an agreement with your specific health fund to eliminate or reduce out-of-pocket costs.

3. Your treatment or procedure must be covered under your policy

If you see a specialist doctor while you’re admitted in hospital, the treatment you’re receiving must be included on your hospital cover in order for your health fund to pay their fees.

Not all health insurance policies cover all procedures, so make sure you know what features you’re covered for and what procedures are services are excluded.

Be sure to read the policy brochure carefully and fully understand what you are and aren’t covered for before seeking treatment with a specialist.

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