Adeney Private Hospital

Zero out-of-pocket, explained: what you pay, what you don't, and how it's possible at Adeney

At Adeney Private Hospital in Kew, zero out-of-pocket means eligible Medibank and Bupa members pay no additional charge, at the point of care, for their surgeon, anaesthetist and related in-hospital fees.

If you’ve heard about Adeney Private Hospital in Kew, you might have heard the phrase “zero out-of-pocket” and wondered what it means. This article is designed to provide the facts and answer some of the most common questions we hear at Adeney.

What “zero out-of-pocket” means

It’s easy to think of the cost of surgery as one bill: the hospital’s. In practice, a private hospital stay can produce multiple separate bills: from the hospital, your surgeon, and the anaesthetist, for example. Even patients with good private cover can be surprised to learn this, because the hospital fee is usually the one that’s fully covered, while the surgeon and anaesthetist fees are the ones that can carry a gap.

That gap is the difference between what your doctors charge and what Medicare and your fund pay back. This is where out-of-pocket costs usually come from.

At Adeney, for Medibank and Bupa members with eligible hospital cover, there’s no gap. Zero out-of-pocket means no additional charge, at the point of care, for:

  • Surgeon and surgical assistant fees
  • Anaesthetist fees
  • Perioperative physician fees
  • Onsite radiology (I-MED Radiology Network)
  • Inpatient pathology (Melbourne Pathology)
  • Inpatient pharmacy (Slade Pharmacy)

What’s not included

It’s important to understand that “zero out-of-pocket” doesn’t mean you won’t pay anything at all. 

You may still be asked to pay an excess or co-payment, depending on the level of cover you hold. That’s set by your fund, not by Adeney, so it’s worth checking your policy or calling your fund directly if you’re not sure what applies to you.

A few other costs can sit outside the zero out-of-pocket arrangement, for either fund:

  • Prostheses not included on the Government’s Prescribed List
  • High-cost medications not listed on the PBS
  • Treatment considered cosmetic rather than medically necessary
  • Services not covered under your specific hospital policy

Before your admission, your treating doctor and the hospital will walk you through informed financial consent, so you know in writing what to expect. If anything about your own situation is unclear, particularly around non-standard care or an unusual clinical circumstance, the most reliable thing to do is ask your surgeon or Adeney’s team directly before your procedure.

Why this matters right now

Data from Private Healthcare Australia, drawn from APRA figures, shows average out-of-pocket costs for hospital episodes have risen 65% since 2020. Fees like that are a big part of why people delay surgery, or avoid it, even when they’re paying for private cover specifically so they won’t have to.

Australians also have a legal right to know what they’ll owe before they agree to treatment. Under private health insurance law, insurers must tell members if a treatment will involve an out-of-pocket cost, so they can give informed financial consent. At Adeney, for eligible Medibank and Bupa patients, that number is zero, known well in advance.

You can choose where you have your procedure

As a private patient, you have the right to choose your hospital and to know what you’ll pay before you agree to treatment. If your GP or specialist hasn’t mentioned Adeney Private Hospital, you’re welcome to ask about it. Where a procedure happens depends on your clinical needs and where your specialist holds admitting rights, so Adeney won’t be the right fit for everyone. Asking the question costs you nothing, and it’s a normal part of understanding your care.

How to find a no-gap surgeon at Adeney

Every surgeon who operates at Adeney has already agreed to the zero-out-of-pocket model for eligible Medibank and Bupa patients. 

You can check Adeney’s list of specialists on the hospital’s website, ask your GP whether they can refer within Adeney’s surgeon network, or call Adeney’s patient services team directly. They’ll be able to tell you which specialists in your required speciality currently operate at the hospital, and help connect you with one if you don’t already have a referral.

FAQs

What does zero out-of-pocket mean at Adeney?
For eligible Medibank and Bupa members, it means no additional charge at the point of care for surgeon, surgical assistant, anaesthetist, perioperative physician, onsite radiology, inpatient pathology and inpatient pharmacy fees. Cover depends on your policy and having served any applicable waiting periods. Some exceptions may apply.

Does zero out-of-pocket apply to every health fund?
No. It currently applies to eligible Medibank and Bupa hospital cover. Adeney welcomes patients from most other Australian health funds, or those with no cover at all, on standard fee terms, with a written estimate provided before admission. It’s worth noting that the final amount may change if unexpected clinical needs arise.

Do I still pay an excess?
You may, depending on the level of cover you hold. The excess is set by your fund, not the hospital. Check your policy or call your fund to confirm what applies to your admission.

What isn’t included in zero out-of-pocket?
Prostheses outside the Government’s Prescribed List, high-cost non-PBS medications, cosmetic treatment not medically necessary, services outside your specific policy, some re-admissions, and ancillary costs like parking or laundry. Speak with Adeney’s team before your procedure if anything about your situation is unclear.

Can I switch health funds to access zero out-of-pocket?
If you move to a fund offering equivalent hospital cover, you’re generally not required to re-serve waiting periods you’ve already completed elsewhere. This is a general right under private health insurance law, worth confirming with your existing and prospective fund before you switch.

How do I ask my doctor to have my procedure done at Adeney?
Ask your GP to note Adeney in your referral, or ask your specialist’s rooms directly whether they operate there. 

How do I know if my surgeon offers zero out-of-pocket at Adeney?
Any surgeon operating at Adeney honours the zero-out-of-pocket arrangement for eligible Medibank and Bupa patients. Check Adeney’s specialist list or call the patient services team to confirm.

Does a lower cost mean lower quality of care?
No. Adeney is held to the same standards as any other hospital and is accredited by the Australian Council on Healthcare Standards (ACHS) against the ACQSHC 10 National Standards.