How to make a health insurance claim
Bupa gives you several easy and simple ways to make health insurance claims, including online and on the spot.
Claiming for your Extras services
Once you've had your treatment or made a purchase (for example, a new pair of glasses), the next step is to make a claim on your health insurance. It's actually pretty simple. Your options are:
On-the-spot health insurance claims
Electronic claiming is the fastest way to make your medical insurance claims. Around 20,000 dentists, physiotherapists, chiropractors, podiatrists, naturopaths, remedial massages therapists, acupuncturists, exercise physiologists and optical outlets around Australia provide this service. After your treatment, swipe your membership card and the claim will be processed automatically. There are no forms for you to complete and you'll only pay the balance of the account.
How to make a claim online
Simply log into myBupa and enter the details found on your receipt via the ‘claim online' section. We'll transfer the payment directly to your bank account (have your BSB and account number ready).*
*Not available for medical insurance claims on ambulance, health aids and appliances, orthodontics, travel and accommodation, pharmacy or medical claims.
How to make a claim by post
Fill out a claim form, attach your invoice and receipt and post to:
Bupa Reply Paid 990
Adelaide SA 5001
and we'll make the payment by EFT or cheque.
If you haven't provided your EFT details on the claim form, then a cheque will be sent directly to you.
Where there is an unpaid amount the cheque will be made out to you but you may still need to settle any outstanding amount with your provider.
Your statement of benefit will be sent to you in the mail.
How to make a claim for your hospital expenses
For your hospital expenses
Use one of Bupa's Network Hospitals and you might not even see a bill. The bill will be sent directly to us by the hospital so we can take care of the finances. If you do receive a bill from the hospital, just send it to us with a claim form from your local Bupa centre or download one from mybupa.com.au
All hospital statement of benefits are issued on a weekly basis.
Claiming within the first 12 months of your current level of cover for hospitalisation
If you are in the first 12 months of your current level of cover (either recently joined or you have changed your cover after joining), we
will need to determine whether a waiting period needs to apply to your admission before Bupa can advise if a benefit will be payable to you. If a waiting period does need to apply no benefits will be payable by Bupa for 12 months from the commencement of your level of cover.
To enable Bupa to assess whether your hospitalisation will have a benefit payable to you, we require you to complete two Medical Certificates (PDF, 105Kb) – one to be completed by your General Practitioner and the other to be completed by your Specialist.
How to make a claim for medical expenses
How you claim your medical expenses that are incurred whilst you are a patient in hospital (for example, your specialist/doctors' fee) depends on whether your doctor uses Bupa's Gap Cover Scheme. If they do, they'll bill us directly. We'll take care of the fees. 100% of the payment will be paid directly to the medical provider on your behalf. When your doctor uses Bupa's Gap Cover Scheme, no cheques are sent directly to you.
If your doctor doesn't use Bupa's Gap Cover Scheme, they may send you a bill for their services. You can then take it to Medicare and then Bupa for payment.
If you take your claim to a Medicare office, Medicare will pay 75% of the Medicare Benefits Schedule Fee. You then need to take your claim to a Bupa centre where the remaining 25% of the Medicare Benefits Schedule Fee is then paid.
Alternatively if you don't have time to visit Medicare, you can use a two-way claim form. When you complete one of these forms, Medicare will forward your claim directly on to Bupa on your behalf. Both Medicare and Bupa will send you a benefit.
When there is an unpaid amount
For any medical insurance claims where there is an unpaid amount for any medical services, the cheque will be sent to you but will be made out to the provider/doctor who provided your medical services. You will be required to forward this onto the medical provider to settle the account for the medical services you received.
Your Statement Of Benefit will be sent to you at the same time as the cheque.
How to make a claim for out-of-pocket expenses
If you have any out-of-pocket costs, your doctor should have informed you of these costs before your admission. In most cases with Bupa's Gap Cover Scheme there is no gap. Just check with your doctor.Source: www.bupa.com.au