Doctors in Australia have the freedom to decide how much they charge for various services – which can vary depending on costs, skills and location.
While the government’s Medicare Benefits Schedule (MBS) fee is set out for most services – this outlines how much of your treatment will be covered by Medicare – doctors can choose to charge above this amount.
The difference between these two costs is commonly known as the ‘gap’.
If you have private insurance from an Australian health fund, you will find some of your medical services as part of private in-hospital treatment are covered by the government and your policy.
For these services, the government pays 75 per cent of the MBS, while the remaining 25 per cent is covered by your health fund.
But many health funds also offer gap schemes, which work to cover the difference between the set MBS fee and the actual charges determined by the doctor in a private hospital.
If the patient – or health fund member – will be faced with additional out-of-pocket expenses after the payment by the government and the health funds, they will be advised by their doctor prior to treatment.
After you are presented with this information, you must give the doctor your informed financial consent before you receive treatment.
Gap schemes can differ between health insurance providers, so it is important to check with your provider or your broker for more details about your treatment.