VMOs can reduce the impact on patients who want to stay with an AHSA fund by pre-booking their procedure before the notice period expires, any time up to and including Monday 3 March 2025.

The AHSA are responsible for advising their members that they will be out of contract with Healthscope unless a new agreement can be negotiated. VMOs should advise their patients who want more information to contact their specific AHSA fund (visit https://ahsa.au/our-funds/ for details).

Healthscope has created a webpage for patients and VMOs who would like more information, including how to change health funds if they choose to: https://healthscope.com.au/Faircare

We are also providing support for patients by responding to any queries we receive, as well as providing information and updates for our hospital staff and VMOs.

No. Our health fund contracts do not contain any direct terms on VMOs and their rights to charge patients for their services.

Yes. VMOs will be entitled to medical gap scheme rates for pre-booked members through the AHSA’s Access Gap Cover Scheme.

Yes. Specialists will be entitled to AHSA Access Gap Cover scheme rates for members that are not prebooked at a Healthscope facility when we are out of contract on and from Tuesday 4 March 2025.

In this scenario, the patient’s episode of care is still funded at the contract rates. The terms and conditions of the contract will continue to apply for the duration of the admitted episode of care.

The table below outlines the circumstance and the duration in which the transitional period will apply to AHSA health fund members.

For emergency admissions, the current contract arrangements and payment schedules continue to apply for a continuous period of three months. Emergency admission (in absence of any agreement) will include any of the following:

• At risk of serious morbidity or mortality and requiring urgent assessment and resuscitation.
• Suffering from suspected acute organ or system failure.
• Suffering from an illness or injury where the viability of function of a body part or organ is acutely threatened.
• Suffering from a drug overdose, toxic substance, or toxin effect.
• Experiencing severe psychiatric disturbance whereby the health of the patient or other people is at immediate risk.
• Suffering from severe pain where the viability or function of a body part or organ is suspected to be acutely threatened.
• Suffering acute significant haemorrhaging and requiring urgent assessment and treatment.
• Patient requires immediate admission to avoid imminent morbidity or mortality and where a transfer to another facility is impractical.

We will continue to provide information including for your patients, and your hospital General Manager will be in regular contact with you.

Additional support will include:

• Opportunities for VMOs to attend online briefings with Healthscope. 
• Healthscope frontline staff provided with additional training to respond to patient queries.
• A dedicated call centre number and email address established for patients and a webpage with additional information.
• Information for your practice team including a briefing sheet that can be given to patients.

We will also seek feedback from you and your practice about how this is working and what else you need.

No. The patient would still have to pay the out of pocket fees for the time spent in hospital where the contract was not in place.

Patients must receive full informed financial consent on their expected out of pocket costs and this should include all scenarios which have been detailed above. Patient eligibility checks must be completed to ensure that a patient is covered for a procedure, especially if there is a change to care type or new presenting illness during their admission. There should be no change to current process, in that a second eligibility check must be undertaken to ensure that the patient is covered for the new presenting condition.

• Current high-cost medical disposables listed in the contract will likely no longer be paid by PHI, and will need to be passed on to the patient.
• There is no change to a prosthesis payment. If it is a listed prosthesis, it is still payable by PHI.
• Pharmacy that is intrinsic to a patient’s episode of care should not be passed on to the patient, with the exception of high cost drugs which may need to be passed on to the patient. The AHSA health funds do not have to consider ex-gratia requests for high-cost drugs when there is no contract with the hospital. However, this is at the discretion of the fund.

• There is no change to pathology and radiology as these services are not covered by Healthscope’s contract with AHSA health funds.

It is your choice as to how you tell your patients about this situation. We have provided you with a letter explaining the situation that you or your practice manager can share with your impacted patients to help them make an informed choice.

We won’t know what these costs might be until AHSA funds advise us the amount they will to pay for their members’ treatment beyond this date. We expect this to happen just before the current contract comes to an end on Monday 3 March 2025.

Under guidelines set by the Private Health Insurance Ombudsman, doctors, hospitals and health funds are expected to work together to provide information to you about the costs associated with your treatment, and any private health insurance benefits payable, prior to your admission to hospital.

If a patient asks about switching funds and you are happy to talk about this, we recommend you provide them with the following information:

Australia’s private health insurance laws allow members to move their cover to another health fund without re-serving waiting periods when transferring to a comparable product. AHSA health fund members can avoid additional fees if they switch to a comparable product with another fund that has the same level of benefits and same conditions as their current product. Healthscope has agreements in place with all other major Australian health insurers including Bupa, HCF, Medibank and NIB.

If you choose to discuss switching with patients, we also recommend you advise them of the following:

* Private health insurance is complex and it can be difficult to compare health insurance products. You should discuss your health insurance needs with the fund you are proposing to switch to so that you understand the new product, how it differs from your current product and can confirm that the product is right for you.

Make sure you consider the products excess, co-payment, full cost and all out of pocket expenses that will apply in the event you require treatment at a hospital. You should also consider if you are obtaining a comparable product. If you switch to a comparable product with another fund that has the same level of benefits and same conditions as your current product, you will not have to re-serve any waiting periods that have already been served. You can compare funds for free at www.privatehealth.gov.au and choose a fund that is not affected.