Health insurance and out-of-pocket expenses: questions to ask

Updated October 2023 | 2 min read

Questions to ask your doctor about private health insurance to avoid hefty out-of-pocket expenses.

Here are our five top questions to ask your doctor to help you make the right decision for your healthcare and help avoid bill shock.

1.  I’m an HCF member. Do you participate in HCF’s gap scheme?

Find a specialist who participates in HCF’s gap scheme for inpatient hospital treatment. To find a specialist who charges no or a known gap (capped at $500 per specialist), use our handy participating provider search tool.

Or ask your doctor if they'll consider a lower charge.

2. Do you provide your services from an HCF-participating private hospital?

HCF members can avoid out-of-pocket costs by going to an HCF-participating hospital. Your specialist might carry out their services at a few hospitals.

Ask whether any of these are an HCF-participating hospital or check for yourself on our Participating Hospitals page.

3. Will there be any other doctors involved in my hospital treatment?

There are times when other doctors will be involved in your care, like anaesthetists or surgical assistants, who may bill separately.

Ask your specialist who will be involved in your procedure and whether their charges are included in the fees they’ve given you.

4. Are there any extra costs involved?

Your procedure might involve surgically implanting items (devices like stents, or prostheses like an artificial hip) or the use of robotic consumables (parts used during robotic surgery that are discarded afterwards).

Usually these are fully covered, but not always. A quick question will clear that up, so you don’t have surprise fees after surgery.

5. What are your total fees for my procedure?

Before you go into hospital, ask each specialist (for example, you might have a surgeon and an anaesthetist) to give you their full fees so you know what you can expect to pay. Double check you’ve been given a total fee rather than just an estimate.

A final figure is the best way to avoid unexpected medical costs after surgery. Total costs for common procedures and the impact on your out of pockets can be found on our Preparing for Hospital page. You can also call us on 13 13 34 to discuss your cover and out-of-pocket costs. We're here to help.