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Medibank-Calvary contracts stand-off: what it means for doctors and patients

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Medibank Private Ltd has announced that its contract with private hospitals operated by Calvary Health Care will end on 31 August this year.

Medibank cited a breakdown in negotiations over the rates Medibank pays for services provided by Calvary hospitals and new quality criteria for the failure to renew the contract, while Calvary has stated the new demands are financially rather than quality driven.

This will not affect the fees paid by Medibank to medical practitioners.

However, medical practitioners will need to ensure patients insured with Medibank seek information directly from Medibank about their out-of-pocket costs for accommodation, theatre and other items if they are admitted to a Calvary Health Care hospital.

Medibank has advised that it will continue to pay benefits for hospital expenses at the current contracted rates for any procedures pre-booked before 31 August, for a period of:

  • nine months if the pre-booking is obstetrics-related
  • six months if the pre-booking is to treat a chronic condition, e.g. chemotherapy or dialysis
  • two months for all other pre-booked admissions.

After this, Medibank will pay previously-contracted Calvary Health Care private hospital expenses at ‘second tier’ rates which are set at 85% of Medibank’s average contracted rate.

Medical practitioners can call Medibank’s dedicated ‘doctor hotline’ on 1300 130 460 for further information.

Georgia Morris