The Gap Medical Expenses

Let’s face it, general day-to-day life can be expensive, and sometimes it feels like we’re drowning in bills with not a holiday in sight. Sound familiar?

So don’t add to those bills unnecessarily by paying out of pocket medical expenses you could have avoided.

What is “The Gap”

When a healthcare provider or hospital charges more for a treatment or service than what is covered by Medicare and Private Health insurance, the amount outstanding is known as “the gap“, which represents your out of pocket expenses for that treatment or service.

Medical fees can vary greatly

Health care providers often charge very different prices for their services so it’s important to find out what they charge and what you are covered for before agreeing to a treatment or service.

University of Melbourne researchers found that charges varied by an average of 70% within specialties, with allergy or immunology specialist appointments charging the most with an out-of-pocket cost for an initial consultation of $141.70. The results of the study published in yesterdays Medical Journal of Australia also found that only 30 – 40% of visits were bulk-billed*.

Private Health Insurers not allowed to cover the gap

Since 1983, private health insurers haven’t been allowed to cover the gap between the Medicare schedule fee and the specialists’ fees for outpatient visits, so it’s important to clarify the doctors fees up-front.

Ask for a cost break-down before you book anything in

Before you go to hospital or undergo a medical treatment you should ask your doctor or the hospital for an estimate of their costs and all charges that might be involved.

Then call us and share your quote with us. We will let you know whether the quote is high and whether there will be a gap payment required. In this case you can then look to use an alternative doctor where a no gap, or reduced payment will be required.

If you are planning on seeing a specialist or having surgery in the future contact us before you commit to eliminate or reduce any gap payments that your doctor might be charging.

For more information on reducing doctor out-of-pocket expenses please read these tips as well as information about the Access Gap Cover Scheme.

If you have any doubts please contact us for a chat.


*source: Herald Sun newspaper, 6 March 2017