Only 25% of members go to hospital in any year and when you do, it can be confusing. So if you have to go to hospital, give us a call on 134 246 so we can provide you with the information you need.

If you have hospital cover with ahm, we can also offer you additional support through our Hospital Support Programs.

For more information on being a private patient in a public, private or day hospital facility, download The Private Patients' Hospital Charter from the Department of Health web site.

Here is a step by step guide to what will normally happen when you go to hospital, what questions to ask and where to find information.

Your hospitalisation		What you need to know
How long have you had your current cover?	Less than 12 months	You will need to understand the pre-existing ailments, illnesses and conditions rule.It is very important to call the fund to confirm if you will be covered.
	Longer than 12 months	There are no waiting periods but you should still call the fund to get more information and check your cover
How did you get to hospital?	Taken by ambulance.	In an emergency situation, you will be taken to the nearest Accident and Emergency section of a public hospital. You are covered in full for ambulance transportation
	Doctor referred you to a specialist for treatment.	Ask your doctor to refer you to a specialist who will participate in the fund's Access Gap Cover Scheme. Make sure you give your doctor the Estimate of Medical Fees form - download a form. You can also search for a doctor.
Where will your treatment take place?	Public	You can elect to be treated as a public patient in a public hospital at no charge, by a doctor appointed by the hospital. You can also elect to be treated as a private patient, with the doctor of your choice. We will cover accommodation and doctor’s charges. More about Access Gap Cover Scheme. Day surgery is sometimes performed in a public hospital. If you have chosen a co-payment on your policy, it applies in a public hospital. More about co-payments.
	Private Hospital	Check our list of Partner Hospitals or call us on 134 246. Sometimes, day only surgery is performed in a private hospital. If you have chosen a co-payment on your policy, it applies in a private hospital.
	Non-Agreement Hospital	Some hospitals don’t have a contract with the fund. If you are treated in a non agreement hospital, you may only receive the default benefit.
	Day only surgery	If you have chosen a co-payment on your policy, it applies in a day only surgery.
How long will you be in hospital?	Day only	You will be admitted and discharged on the same day
	More than 2 nights	We may be able to help you leave hospital early or prevent a longer stay with services in your home. Call our Member Support Program nurses on 1800 653 316 for more details. Early discharge programs are not available at all hospitals.
	More than 1 night after the birth of your baby	Our Maternity Options program means you can choose to recover at home instead of hospital after the birth of your baby. We will work with your doctor to provide all the clinical services you need at home. Extra benefits such as nappies or home cleaning may be available.
What treatment are you having?	It’s important that you understand your treatment	Informed Consent is your right to know exactly what is involved with your treatment. Make sure you ask for: A full explanation of the procedure and any likely complications If there are other treatment options How long you will take to recover How long you will have to wait for test results You can also email our Hospital Support staff who may be able to provide support.
What about the doctor's charges?	There are likely to be a number of doctors and other providers involved in your care including: Lead specialist Anaethestist Pathologist	You have the right to Informed Financial Consent. This right is endorsed by the Australian Medical Association. Ask your specialist if they can tell you who else will be involved in your treatment. Provide them with a copy of the fund’s Access Gap Cover Scheme and estimate of medical fees form - download a form . Ask how much you will have to pay.
What happens on admission to hospital?	In an emergency	You will be taken to the nearest Accident and Emergency section of a public hospital, or a private hospital if they have this facility. If you need to be admitted, you can choose the hospital. Check if it is a Partner Hospital or call us on 134 246.
	You admit yourself into the hospital	The hospital will firstly confirm your cover with the fund (or may do so prior to your admission). If you have a co-payment on your policy, the hospital will usually require you to pay it on the day of your admission. Make sure you have your credit card or money for the cost. The hospital will also provide you with Informed Financial Consent. This will detail any additional charges relating to your treatment that are not covered by the fund. Ask for a Patient’s Code from the hospital. Most have them and they detail your rights and the responsibilities of doctors and the hospital. Ask about your enrolment on our Recovery Options Program. If you’re not enrolled, ask the hospital staff to contact our Member Support Program nurses on 1800 653 316.
What about the doctor's bills?	Your doctor / specialist participated in the Access Gap Cover Scheme.	They will usually send the bill directly to us. We’ll pay the bill and send you a statement. Refer to your Estimate of Medical Fees form for any differences you may have to pay.
	Your doctor / specialist did not participate in Access Gap Cover	You will have to pay the difference between the Schedule Fee and the doctor’s charge. This is called “the gap”. Call us for a “Two Way Claim Form” to make claiming easier. Take the account to Medicare who will then forward it to the fund.
What about the hospital charges?	Your hospital cover means you are covered in full for agreed theatre and accommodation charges (after your co-payment amount is paid).	The hospital will bill the fund directly and we’ll send you a statement of the benefits we have paid.

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