If you have agreed to an excess or co-payment on your policy, you will pay this amount upon being admitted to hospital (this is payable to the facility, not your health fund). So long as the service or treatment you are receiving in hospital is as an inpatient and isn’t excluded or within waiting periods, your health fund should be paying for 100% of these fees. If there were to be any additional expenses for yourself (such as meals or accommodation for boarders, daily newspapers, cable television etc), then these will be provided to you before to your admission.
Every possible medical treatment or surgery that’s subsidised by the Australian Government is indexed with a Medicare Benefit Schedule (MBS) item number. Medicare and the Department of Health maintain close to 20,000 of these listings, all with their own individual dollar amounts and they effectively act as a ‘recommended retail price’ for doctors to charge.
So long as you hold Medicare entitlements, 75% of the Medicare Benefit Schedule fee will be paid by Medicare and remaining 25% is paid by the health fund. However, should your doctor choose to charge above this amount, the difference between the MBS fee and what the doctor is charging will traditionally be your out-of-pocket.
Example: If your doctor charges $2,000 for a surgery that has been classed on the MBS listing as $1600, then Medicare will pay $1200 and your health fund will contribute the remaining $400. The left over $400 is your out-of-pocket cost.