How to avoid hidden costs at the hospital
Many private patients are left scratching their heads when they leave hospital with a gap payment for their medical bill. Isn’t private health insurance meant to cover that?
For a large proportion of private hospital payments, not only are their bills large they are also not given the information prior to their surgery.
So what is the “gap” that we keep hearing about?
When your doctor charges more than the government agrees to pay for your treatment, there is a “gap” in the bill. So even though the government will pay 75 per cent of a specific amount (this is the Medicare Benefits Schedule fee), and your health insurance pays the other 25 per cent, the doctor can actually charge more.
What is a “no gap” agreement?
Some doctors set up an arrangement with the health funds to ensure the gap is covered. A “no gap” agreement is where your doctor is able to recover the entire gap from your health fund. This is the best-case scenario in terms of protecting your hip pocket.
How is it different to a “known gap” agreement?
If your doctor recovers some of the gap from your health fund and bills you for the rest, this is a “known gap” agreement. While it’s not as ideal as a no-gap agreement, at least you will know how much you will need to pay. The trouble is, not all health funds in Australia offer known gap agreements. It pays to ask in advance.
What causes the extra costs?
Gaps can occur when there are other specialists involved with your surgery (such as an anaesthetist or radiologist); when there are charges for your accommodation; when you need “extras” such as a pacemaker or prosthetic leg; or when you need tests such as X-rays, which can incur separate fees.
Which fund should I choose to reduce my gap payments?
Each health fund is different, they set up their own gap scheme and so your expenses will depend on which fund you are with and what procedure you are having.
Before you make any changes, talk to your health fund and your surgeon to determine the best possible outcome for the bill. A doctor is able to decide on a specific amount to charge an individual patient. So they may charge less for a pensioner, but charge more for someone who is still working.
Let the surgeon know whether the charges will make it hard for you to afford the surgery. Speak to your health fund to ensure that you are covered for the specific surgery you are undertaking.
Once you have all of the details for your surgery you can start ringing around to find out what charges you can expect.
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