Information on Health Insurance Claiming

Claiming procedure

How to claim with Budget Direct Health Insurance:

Hospital Claims

Budget Direct Health Insurance will pay your hospital claims directly. You’ll need to present your membership card when you’re admitted, but in most cases you won’t need to contact Budget Direct Health Insurance. You can view the details of all claims paid on your behalf in our Online Member Area.

Extras Claims

With Budget Direct Health Insurance Extras Cover, you can use your membership card to claim your benefit on-the-spot (assuming your health care provider has this facility).

Once you’ve received the service, they’ll swipe your membership card through their terminal, enter your claim details, and your claim will be processed electronically—usually within seconds. Once Budget Direct Health Insurance authorises your claim, you simply pay any difference between the full fee and the amount Budget Direct Health Insurance will pay.

If your claim is rejected unexpectedly, your provider should contact Budget Direct Health Insurance on 1300 665 623 to discuss your claim.

If your service provider doesn’t have an electronic terminal, you’ll need to pay for the service in full and then claim it online with Budget Direct Health Insurance. Simply log in to our Online Member Area. You’ll need to keep your receipt for two years in case there’s an audit (in which case you’ll need to send your receipt to Budget Direct Health Insurance).

In some situations (e.g. you’re claiming a service you received more than six months ago, or the service was for Orthodontic treatment) you may not be able to claim online. In this case you’ll need to submit your claim via mail.

To submit a claim by mail, Budget Direct Health Insurance needs:

  • A completed claim form
  • The fully-itemised health care account(s), as well as the original receipt(s). (Sorry, but we can’t accept photocopies or faxes.)

An orthodontic treatment plan certificate is no longer required before orthodontic benefits will be paid. For the purpose of benefit payments, orthodontic treatment is regarded as commencing on the date the appliance is originally fitted. Limits apply every calendar year.

This paperwork should be sent to:

Budget Direct Health Insurance Claims
PO Box 761
Geelong, VIC, 3220

Damages or compensation

Where you or your dependants have a right to claim damages or compensation from any other person or body, you need to pursue that entitlement before you lodge a benefit claim with Budget Direct Health Insurance.

You should lodge a claim with Budget Direct Health Insurance only if legal action was unsuccessful (you’ll need an official letter of denial ). This includes WorkCare, TAC, public liability and third party claims.