FAQs: Healthscope agreement

FAQs: Healthscope agreement

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The Healthscope agreement

Why is Teachers Health's agreement with Healthscope scheduled to end?

There are two reasons this has come about:

Higher charges

Healthscope wanted to increase their charges for our members’ hospital admissions, to a level we believe was unacceptable. When we didn’t agree to these charges, they moved to terminate our contract.

We take affordability seriously. Agreeing to the higher charges would have a negative impact on our members' premiums. As a not-for-profit, member-focused health fund, it would be irresponsible for us to agree to charges we find unfair then pass the cost on to you.

Quality of care

Healthscope’s proposal included additional charges for them to comply with industry minimum standards for rehabilitation and mental health services. We want the best quality of care for our members and expect industry minimum standards to be met as a baseline.

Our take

We’re incredibly disappointed we haven't reached an agreement at this point in time, but rest assured we’ll do everything we can to provide you with access to the private hospitals of your choice. We’ve successfully negotiated agreements with more than 500 hospitals across Australia.

Learn more about choosing a hospital

 

Who’s negotiating with Healthscope?

We're one of 28 funds that are part of the Australian Health Services Alliance (AHSA). The AHSA is a services company that represents small to medium-sized health funds, allowing resources to be pooled together when responding to changes in the private health insurance industry. This includes the AHSA representing us for contract negotiations.

 

Are Healthscope terminating private hospital agreements with any other funds?

While the details of contract negotiations are confidential, all health funds go through the same negotiation process each time a contract comes up for renewal.

At this stage, five other AHSA health funds have had termination notices from Healthscope – Australian Unity, CBHS, CBHS corporate, CUA and Reserve Bank. 

 

If other funds have agreements with Healthscope, why can’t you?

While other funds’ agreements are confidential, we do know that hospital contracts are a balancing act. Our goal is to help you access quality treatment at a reasonable cost. That means giving you a wide choice of hospitals and keeping premiums as low as possible.

Other funds have similar issues when their agreements are up for renewal. At the time of writing this includes the five we mention above. 

 

Which hospitals are in the Healthscope network?

Check this Healthscope hospital list

 

Which hospitals does Teachers Health have agreements with?

We have agreements with more than 500 hospitals across Australia. Find one now

 

How many other hospitals/hospital groups are you in negotiation with, and should I be worried?

There’s no need to worry. The AHSA represent 28 health funds and have been very successful in negotiating terms that meet the needs of the health funds (and their members) and private hospitals for many years. We don't expect this to change.

Unfortunately, Healthscope’s demands were unrealistic and not something that we were comfortable with – particularly the additional charges for them to comply with industry minimum standards for rehabilitation and mental health services. We expect this to be a given.

 

Will all members be notified of the termination?

We’re required to provide 30 days’ notice to members who:

  • have been admitted to a Healthscope Hospital in the last 12 months
  • live within a 15km radius.

Members who don’t fall into either group will be notified in the coming weeks.

 

How will you be notifying members? 

By email or post – depending on your contact preference. If you’ve selected post, your notification may take up to five business days to arrive (due to COVID-19-related delays). 

To change your contact preference, go to Online Member Services > My membership < Contact details, scroll down to Contact preferences and click Edit.

Healthscope hospital admissions

I’ve pre-booked treatment at a Healthscope hospital. Will I have to cancel it?

No – you can go ahead. Healthscope will honour bookings made before 8 June 2020 under the old agreement. The change would only affect future bookings.

 

I’m booked in to a Healthscope hospital to have my baby. Will I have to switch?

No. If you’re already booked in, you’ll be covered under the old agreement.

 

I’m in the middle of a course of treatment at a Healthscope hospital. Can I continue?

Yes – up until 7 December 2020 you'll be covered under the old agreement. 

If an agreement isn't reached, and you want the same specialist to treat you after this date, ask if they can do so at another (agreement) hospital.

 

My surgery was booked and cancelled due to COVID-19.  Where do I stand?

If your surgery was postponed then re-booked for an admission date before 8 December 2020, you'll be covered under the old agreement. 

If your surgery hasn't been re-scheduled yet, it won't be considered 'pre-booked'. Ask your specialist if they can re-book it before 8 June (for admission before 8 December 2020) so you can be covered under the old agreement.  

 

Can I still claim if I decide to be treated at a Healthscope hospital in the future?

Yes, you can. If a new agreement isn't reached, you can still claim towards a Healthscope hospital bill, but you may have higher out-of-pocket costs than you would at an agreement hospital (after 8 June 2020).

If you decide to go to a Healthscope hospital, please make sure you’re clear on, and agree to, all the costs involved upfront this is called Informed Financial Consent. No one wants to be faced with unexpected bills while they’re recovering.

Learn more about choosing a hospital and Informed Financial Consent

 

My specialist works out of a Healthscope hospital. What should I do?

Ask your specialist if they can treat you at another hospital – many specialists have other options. If so, you can use our search tool to check if it’s an agreement hospital. If you need help with this, please get in touch. You can call us on 1300 727 538.

 

There aren’t any other private hospitals in my area. If you don't reach an agreement with Healthscope, how can I use my cover?

Please ask your specialist if there are any other options for your treatment. If so, you can use our search tool to check if it's an agreement hospital. If you need help with this, please get in touch on 1300 727 538.

 

What do I do in an emergency? My local A&E department is at a Healthscope hospital.

You can access a Healthscope hospital Accident and Emergency department. If you're admitted in an emergency before 8 September 2020 you'll be covered under the old agreement.

If an agreement isn't reached, after 8 September 2020 the hospital will be non-agreement and you may have significant out-of-pocket costs. 

Hospital cover premiums

If you don't reach an agreement with Healthscope, will my premiums go down? 

No. The rising cost of healthcare is a key factor in premium increases. At Teachers Health we work hard to keep premiums as low as possible whilst still providing the quality cover members expect. 

If you’ve previously been admitted to a Healthscope hospital it’s wise to plan future admissions at an agreement hospital to avoid or reduce out-of-pocket costs. 

If you choose a Healthscope hospital – or another non-agreement hospital – we still pay a benefit towards your hospital bill, but it’s restricted to no less than 85% of the average charge for the same treatment. This means you may have significant out-of-pocket costs.

Learn more about choosing a hospital

Switching funds

There's a number of Healthscope hospitals in my area. I’m considering switching to a fund that still has an agreement with Healthscope.

We get it. And we’re genuinely sorry if an agreement isn't reached and this causes issues for you. It’s not an outcome that we want for our members.

We encourage you not to seek out another health fund at this stage. We’re still working with Healthscope with the aim of reaching an agreement that we believe is fair.

If you do explore other options, please keep the following in mind:

  • Check the fund has an active agreement with Healthscope and this isn’t due to change in the near future
  • All health funds offer a minimum 30-day cooling-off period. Provided you haven’t claimed, you can easily switch back to us if an agreement is reached within that time
  • If you have Hospital and Extras cover with us, you can always switch your Hospital cover to another fund and keep your Extras with us.

 

If I switch funds then you reach an agreement with Healthscope, can I transfer back?

If an agreement is reached, we’ll contact you. All health funds offer a minimum 30-day cooling-off period. If you haven’t claimed during that time, you can get a full refund and transfer back to us.  

 

If I switch funds, will my waiting periods be transferred over?

Yes. Any waiting periods already served will be transferred over to the health fund of your choice. If your new cover includes things you weren't covered for previously (or were covered at a lower level) you'll have to serve waiting periods for those services.