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How do I Avoid Out of Pocket Expenses?

To help reduce or eliminate your out of pocket hospital expenses, we participate in the Access Gap Cover Scheme.
What’s the Access Gap Cover Scheme?
The scheme is administered by the Australian Health Services Alliance to help reduce or eliminate your out of pocket hospital expenses. Almost 9 out of 10 medical services under the Access Gap Cover Scheme have no out of pocket expenses.
However, medical practitioners can decide on a case-by-case basis whether or not they choose to participate in the scheme.
What if my medical practitioner decides to not participate in the Scheme?
Medicare will pay 75% of the fee set in the Medicare Benefits Scheme (MBS) and will pay the other 25% of the scheduled amount. Because medical practitioners can set their own fees, if your invoice is more than the MBS fee you will need to pay the difference.
If you are going to hospital, for your own peace of mind please ensure you confirm the following:

The in-hospital services checklist
Ask your medical practitioner:

  • What are your fees?
  • Will my private health insurance cover your fees?
  • Can you tell me how much out of pocket I will be, if at all?
  • If I cannot afford to pay immediately, can I set up a payment plan?
  • Will I receive one bill or several?
  • What is the MBS number for my treatments/s? 

Ask your hospital:

  • Do you have an agreement with my insurer,
  • Am I required to pay extra for my hospital accommodation?
  • Are there any out of pocket expenses I should know about?
  • Click here if you would like to know more about Medical Cover.

Going to hospital? You should definitely check our amazing Going to Hospital Guide.

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