What’s not covered by private health insurance?

Q. Carol
A trip to the specialist often results in expensive tests and I then spend my time going back and forward between Medicare and my health insurer to try and get reimbursed, often to no avail. Is this correct? Should I be left out of pocket?

A. Private health insurance will not cover you for medical services which are provided out of hospital and are covered by Medicare. Depending on which test you are having, these may not be covered by either Medicare or your health insurer, so it’s always worthwhile asking before you have the tests.

It’s also worth noting that should you be admitted to hospital, private health insurance may not cover the complete cost of the doctor’s services. It may also entitle you to be seen by the doctor of your choice only in a state hospital, rather than a private facility.

Before agreeing to undertake any treatment, you should contact your private health insurer.

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