Understanding specialists’ costs
One of the great things about private hospital cover is that you can choose your specialist. If you haven’t been to hospital before this may not sound like a big deal, but it can be.
It means you can pick someone you trust and feel comfortable with. It’s also a chance to limit your out-of-pocket costs (what you pay). Hospitals bill separately – we’ll talk about that in step 4.
For many Aussies, specialists’ fees are a source of misunderstanding. You may not know that in the private system specialists can set their own fees. Some charge a lot more than others, and a higher price doesn’t guarantee higher quality.
If your specialist charges more than the fee set out by the government in the Medicare Benefits Schedule (MBS), you’ll have to pay the difference (known as the “gap”).
To avoid, or minimise, gap payments ask your specialist if they’ll treat you under our Access Gap Cover scheme. If they say yes, you’ll pay a known (agreed) gap, or even nothing at all.
Finding an Access Gap specialist
You and your GP can use the Healthshare tool to search for specialists who’ve treated other people under Access Gap. Then you can ask if they’ll do the same for you (it’s up to them if they want to participate in the scheme).
Once you’ve chosen a specialist ask them about any other doctors who may be involved in your treatment, like an anaesthetist or assistant surgeon, and whether they’ll treat you under Access Gap. This is something many people have no idea they should be asking. We don’t want you to be one of them.
Only once you’ve seen, and understood, a breakdown of all the specialists’ costs can you give Informed Financial Consent.
While you’re there, ask your doctor for every MBS item number that’ll figure in your treatment. Then call us on 1300 344 00 so we can double check you’re covered.
Short term pain, long term gain
This process may sound like a lot of work, especially when all you want to do is get better – and, frankly, it can be. But it’s worth doing. Even if you’re uncomfortable talking about money, having these conversations upfront is the best way to understand the costs and do everything you can to avoid bill shock later on. So please do persist.