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How to make a hospital claim

After your hospital stay, there may be some paperwork and claims to work through relating to your hospital costs, inpatient medical costs, ambulance (if you used one) and included extras. 

How you pay for your treatment will differ depending on the agreement Bupa has with the hospital you visited, whether your doctors used the Bupa Medical Gap Scheme, and your level of cover.

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Pay and claim for hospital costs

All Members First and Network hospitals will ask you to complete claim forms on admission, which they’ll send to Bupa on your behalf.  

The hospital will ask you to pay any applicable excess and/or co-payment, and the fixed fee (if applicable), upon your admission.

Any treatment or services not covered by your Bupa hospital policy will be discussed with you prior to receiving treatment (this is also called informed financial consent). If there’s an associated fee, it’ll need to be paid for before you’re discharged. 

Learn more about:  

If you visit a private hospital that doesn’t have an agreement with Bupa, you may be asked to pay for some charges associated with your stay. The hospital will discuss the charges with you before you’re admitted (this is also called informed financial consent). 

To make a claim: 

  1. complete a National Private Patient Hospital Claim Form (PDF, 110KB) (you can also ask your hospital for a copy)
  2. complete a Bupa claim form (PDF, 865KB) or claim via myBupa
  3. submit your claim, invoice from the hospital and forms via myBupa, mail them to the address on the form, or submit in person at a Bupa store near you.

Learn more about Bupa hospital agreements.

You’ll need to complete a National Private Patient Hospital Claim Form (PDF, 110KB) (you can also ask your hospital for a copy).

The hospital will send the bill directly to Bupa.

Learn more about what you’re covered for as a private patient in a public hospital.

If you're an Australian citizen or permanent resident entitled to Medicare, Medicare will usually fully cover your costs. Learn more about Medicare and hospital costs.

Claim with myBupa

myBupa makes it easy to lodge claims for the things you may be covered for, like:

  • hospital costs 
  • medical costs 
  • ambulance services 
  • accident or injury benefit  
  • travel and accommodation for essential medical treatment1 
  • extras 
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Pay and claim for medical costs 

If your doctor uses Bupa's Medical Gap Scheme they can choose to charge you no gap or reduce your out-of-pocket costs to a maximum of $500 per doctor. This means you’ll pay either: 

  • no gap: Your doctor will bill Bupa directly, so you don't need to pay anything. 
  • a known-gap fee: Your doctor will Bupa directly, and you may be out-of-pocket up to $500 per doctor (you may need to see multiple doctors for one procedure). 

Your doctor will bill you directly for your treatment, usually before you’re admitted to hospital. 

There are two ways to pay and claim after your procedure: 

  1. pay your doctor, then claim: Complete a Medicare claim form and Two-way claim form (you can download, print and post them or complete them online via myGov). You may receive a benefit from Medicare and Bupa. 
  2. claim, then pay any gap to your doctor: Complete a Medicare claim form and Two-way claim form (you can download, print and post them or complete them online via myGov). If there’s a gap fee remaining, you’ll need to pay this to your doctor. 

You can also contact us to have the relevant forms posted to you. 

Learn more about claiming with Medicare.

If you're an Australian citizen or permanent resident, Medicare will usually fully cover your costs. Learn more about Medicare and hospital costs.

Pay and claim for surgically implanted devices and medication

  • If your implanted device is on the Australian Government's Prosthesis List, and you’re treated in a Bupa agreement hospital, the hospital will bill Bupa directly. Learn more about prostheses and private health insurance. 

In both cases, there’d likely be nothing left for you to pay.

  • If your implanted device isn’t on the Australian Government's Prosthesis List (e.g. external breast prostheses, cosmetic surgery, and custom devices), you may need to pay in full yourself. Learn more about prostheses and private health insurance. 
  • If your medication is a high-cost drug (i.e. a drug not listed on the PBS, or a drug being administered for a purpose other than the intended purpose defined by the Therapeutic Goods Administration (TGA)), and you're in a private hospital with an agreement with Bupa, then the hospital will have discussed any out-of-pocket costs you may need to pay (also called informed financial consent) before you received treatment. The hospital will send any remaining portion of the bill directly to Bupa, which we will pay. 

Understanding your Bupa Statement of Benefits

Your Statement of Benefits is a document that explains the benefits paid by Bupa towards your treatment. 

Once we’ve processed payments for your hospital visit, you may receive a statement of benefits. You can also check your processed claims in myBupa. 

You may also receive a statement of claim and benefit from Medicare. 

What to do with your Bupa Statement of Benefits

  • Make sure your personal details are correct. 
  • Check your statement against the estimates you received from your doctors/specialists and the hospital. Learn more about informed financial consent and what to do if your estimate and statement don’t match. 
  • Check if there’s any gap to pay to your specialist or hospital. Learn more about out-of-pocket costs. 

Note: you may see costs paid to specialists you don’t recognise, but who provided a service in hospital, like your anaesthetist. Contact us if you have a question or notice any mistakes on your Statement of Benefits. 

If a cheque for your specialist is included with your Bupa Statement of Benefits, please forward this on to them (by post or in person). 

Claims related to hospital

We can cover some travel and accommodation costs when essential medical or hospital treatment can't be provided nearby1. Learn more about travel and accommodation benefit.

You can either claim using myBupa, or download and complete a travel and accommodation expense form.

Claims for included extras

If you have extras cover2, using it is a great way to prepare for hospital and help speed up your recovery afterwards. 

You may be able to claim on-the-spot using your Bupa card when paying for your appointment. You can easily make an extras claim using myBupa, or we can help you claim via myBupa at your nearest Bupa store.

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Check or change your Bupa cover

If you’re a current Bupa member and want to check what you’re covered for, you can sign in to myBupa or contact us. 

Want to review or change your cover? We can help with that too (waiting periods may apply). 

Sign in to myBupaReview or change cover

Get Bupa hospital cover

Thinking about getting hospital cover or switching to Bupa? 

Bupa helps almost 4 million people in Australia live longer, happier, healthier lives.  

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1 Helps cover the cost of travel for essential medical or hospital treatment not available close to home, where the total return distance is 200 kilometres or more from where you live. Up to $100 per person, per trip for travel expenses and $50 per night up to $150 per person, per trip for accommodation. 2 month waiting period and eligibility criteria apply.

2 Yearly limits, waiting periods, benefit claiming restrictions, fund and policy rules apply.