Informed Financial Consent

The following information relates to making payment for an appointment at our hospitals. Before any procedure with us, you will be provided with a quote and also an Informed Financial Consent which displays estimates of all costs relating to your procedure with Montserrat. This is issued regardless of whether you have a health fund or not.

You will be phoned to advise these costs normally 24-48 hours prior to your procedure. Then on the day of your procedure, one of our reception team members will step you through the costs and ask you to sign this form. By signing, you are accepting the terms and you are acknowledging and accepting the following items, which are conditions of this admission. Without having signed this document and making payment in full, you will not be able to continue on to have your procedure done.

 (a) Actual expense incurred may differ from the estimate provided.

As we are a Simplified Biller, we make every effort to simplify and provide an accurate estimate of the expenses you may incur, additional costs are sometimes incurred during your hospital stay. The actual expense incurred may differ from the estimate provided before your admission due to any of the following:

• We rely on information provided by your Health Fund at the time of checking with them, however sometimes it is possible for this to change
• Your treating doctor(s) may vary the proposed treatment, procedure or the proposed length of stay
• You may incur sundry charges during your stay (e.g. take home medications)
• Where prosthesis (an implanted medical device) is required for your treatment there will be at least one device that is fully covered by your health fund (if you are insured). However, based on your specific clinical need, your doctor may recommend a device that requires a gap payment by you. Though your doctor should generally advise you if this is the case, as with any medical procedure, if unforeseen circumstances should arise during the procedure it may be necessary for your doctor to use a different or more costly prosthetic device. If this happens there may be additional costs to you.
• You may incur fees associated with the procedure but not with our hospital – for example X-Ray’s or pathology specimen fees

(b) You agree to pay any balance of expenses actually incurred

Your final account will reflect:

• The actual procedure performed, treatment and services provided and your length of stay at the hospital;
• Prosthetic items used in your treatment; and
• Any balance payable by you.

As noted on the Informed Financial Consent, actual costs that are known and advised prior to your admission are payable before or on admission and any additional costs are payable on discharge.

As a condition of admission, once you have indicated your acceptance of these terms, you will be taken to have agreed to pay your final account. If you have genuine concerns, or a bona fide dispute regarding the final account (for example you did not receive a service or an item listed) you agree to raise this with the hospital as soon as possible after receiving the account and to use your best efforts to resolve any dispute at the time of discharge or within 7 days of discharge.

(c) You are required to pay the full amount or any outstanding balance if your insurer (or other payer) does not cover the cost of treatment

If for any reason your health fund/insurer/Medicare does not cover your treatment in full, you are responsible for paying the balance of the hospital’s rates. If for any reason health insurance benefits do not apply you must pay the charges that arise from your admission to the hospital.

We will make contact with you as soon as possible after your procedure to advise if any additional costs arose.

(d) You are responsible for accounts from other providers

You are responsible for payment of other accounts you may receive, which may include:

• the treating doctor(s) or surgeons(s) (where a non-Montserrat Doctor was used)
• the assisting surgeon(s) or resident doctor(s);
• the anaesthetist (where a non-Montserrat anaesthetist was used)
• pathology services;
• radiology services;
• physiotherapy

If you are unsure what services you may receive during your stay and wish to know what accounts you may receive, please contact us directly on 07 3833 6781 to enquire.