A surgically implanted prosthesis provided as part of an episode of hospital treatment or hospital substitute treatment, is covered on all Astute Simplicity Health hospital products, providing the service attracts a Medicare benefit and the prosthesis has been approved for the payment of private health fund benefits by the Department of Health.
What is a surgically implanted prosthesis?
A surgically implanted prosthesis is a piece of equipment that is surgically implanted into the body during a hospital procedure, to replace or assist a bodily function. For example, an artificial hip, a pacemaker, a cardiac stent, intraocular lenses, screws and plates.
Will I be fully covered for a prosthesis?
The Department of Health produces a list of approved prostheses showing what benefit health funds should pay for each prostheses. Most Government approved surgically implanted prostheses are fully covered by your hospital cover. However some will require a patient contribution (gap) to be paid if the supplier charges above the listed benefit.
What should I do if I require surgery that may involve a prosthesis?
If you require surgery that involves a surgically implanted prosthesis, you should check with your surgeon to see if a patient gap applies to the prosthesis being used.
If the prosthesis is not fully covered, ask your surgeon if there is an appropriate no gap option.
If a prosthesis that has a patient gap is to be used, your surgeon should obtain your informed financial consent and advise you prior to surgery of the amount of gap you will be required to pay.
You should also contact Astute Simplicity Health prior to surgery to confirm your benefit entitlements.