Hyperbolic metamaterials are materials in which at least one principal dielectric constant is negative. We describe the refractive index surface, and the resulting refraction effects, for a biaxial hyperbolic metamaterial, with principal dielectric constants $epsilon_1<0$, $0<epsilon_2 eqepsilon_3$. In this general case the two sheets of the index surface intersect forming conical singularities. We derive the ray description of conical refraction in these materials, and show that it is topologically and quantitatively distinct from conical refraction in a conventional biaxial material. We also develop a wave optics description, which allows us to obtain the diffraction patterns formed from arbitrary beams incident close to the optic axis. The resulting patterns lack circular symmetry, and hence are qualitatively different from those obtained in conventional, positive index materials.