What happens when you arrive at hospital in an emergency?
If an ambulance has been called, you’ll be taken to the nearest public hospital emergency department. Most private hospitals are not staffed or equipped to handle emergencies. So even if the patient has private health insurance and requests a private hospital, the ambulance is unlikely to respond to this request.
If you take yourself (or a family member) to a private emergency facility, it’s important to understand that private health insurance does not cover the cost of emergency treatment in a private hospital. You will have out-of-pocket expenses if you receive private emergency treatment.
What happens in emergency at a public hospital
Whether you arrive at a public emergency department in your own car or by ambulance, the hospital triage nurse will make an initial assessment. All patients are triaged on the basis of urgency of medical need and ranked according to five categories.
- The patient has an immediately life-threatening condition and must be treated within two minutes (typically unconscious with a critical injury or heart attack).
- The patient’s condition is imminently life-threatening and must be treated within 10 minutes (such as chest pains, difficulty breathing and severe fractures).
- The patient has a potentially life-threatening condition and should be treated within 30 minutes (such as heavy bleeding, major fractures or dehydration).
- A potentially serious condition should be treated within one hour (such as a foreign body in the eye, sprained ankle, migraine or earache).
- Less urgent conditions should be treated within two hours – but patients will often need to wait longer than this to be seen for minor illnesses or symptoms that may have been present for more than a week.
Everyone is entitled to receive emergency care in a public hospital. Just show your Medicare card and there’ll be no charge for your treatment. Overseas visitors will need to claim through their travel insurance (or cover the cost personally).
If you’re a serving member of the ADF, you could be asked to pay at the time of your emergency treatment. You’ll be reimbursed for any charges when you submit the account to your Area Health Service. If you’re admitted to the hospital you should notify your unit – you know the drill.
What happens after the emergency
Many emergency patients will receive the treatment they need in the emergency department and after some observation, will be discharged for rest and recovery at home.
Some patients will require further treatment immediately and will be admitted to one of the public hospital wards as an in-patient. If that’s the case you’re entitled to 100% Medicare funded public hospital benefits and, as a public patient, you won’t have any out-of-pocket expense.
You might need further hospital treatment that is not urgent. If you don’t have private health insurance you’ll be placed on the public hospital waiting list. But if you are privately insured you can take control of your treatment. With private health insurance you can seek further treatment from a doctor of your choice and receive treatment almost immediately through the private hospital network.
- Everyone who arrives at a public hospital emergency department will receive Medicare funded emergency treatment. The length of time they wait for treatment will depend on the urgency of their medical need.
- Private hospital insurance does not cover emergency department treatment in a public or private hospital.
- If you are admitted as a public patient to a public hospital following an emergency, you are entitled to 100% Medicare funded treatment with no out-of-pocket expenses.
- If you elect to be treated as a private patient in a public hospital, you will not be treated any faster than other patients; you may not have a private room; and you could have out-of-pocket medical expenses (or an excess to pay).
- If you are privately insured you can seek further treatment after an emergency almost immediately by accessing the private hospital network. You will not have to join the public waiting list.