"Emergency admission under OVHC"

My in-law recently arrived in Australia from overseas and unfortunately suffered a fall. They were assessed by an after-hours doctor at St George Private Hospital and was referred to the Emergency Department at St George Public Hospital.

Upon presenting to the Emergency Department, the admissions receptionist requested that we pay a significant amount upfront, despite my in-law holding valid Overseas Visitors Health Cover (OVHC). The receptionist also advised that we could seek full reimbursement later.

However, when we contacted our insurer, they advised that this information was incorrect. They explained that, as an OVHC holder, my in-law should be able to be admitted as a privately insured patient in a public hospital and that the hospital should bill the insurer directly. The insurer advised that only any applicable gap payment should be payable by the patient. They also stated that the hospital should use the appropriate billing codes for overseas health insurance holders.

Despite this, the receptionist continued to insist that we pay the full amount upfront rather than processing the admission under the OVHC arrangement. As a result, we left the hospital without receiving treatment or being seen by a clinician in the Emergency Department.

We have previously attended another hospital under the same overseas health insurance policy and were not asked to make any upfront payment. The hospital billed the insurer directly and processed the admission under the OVHC arrangement without issue.

I am therefore concerned as to why two hospitals within the same Local Health District appear to apply different processes for patients with Overseas Visitors Health Cover. It also raises the question of the value of maintaining overseas health insurance if patients are still required to pay substantial amounts upfront before receiving care.

I also note that the form presented to us referred only to "Medicare-ineligible patients" and did not appear to address patients who hold private overseas health insurance.

I would appreciate clarification regarding the hospital's policy for OVHC holders and whether the advice provided by the admissions staff was consistent with the billing policies