PrivateHealth.gov.au

Gap cover doctors

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A 'medical gap' is any out-of-pocket expense incurred by a patient for their medical treatment during their stay in hospital, reflecting the difference between the total fee charged by the doctor and any Medicare rebate and health insurer benefit.

Unless your health insurer has a gap cover arrangement in place with your doctor which will cover all of your doctor's charge, you may have to contribute towards the doctor's bill out of your own pocket. It is up to the doctor to decide on a case-by-case basis whether he or she wishes to use an insurer's gap cover arrangement.

It is important that you contact your health insurer before you receive hospital treatment, where possible, to check whether your doctor is participating in the insurer's gap cover arrangements. You should also ask your doctor(s) for an estimate of their costs and how much is likely to be covered by your health insurer. Your health insurer should also be able to assist with calculating likely out-of-pocket costs.

The following list provides links to each insurer. Some have specific information on their site, or you may have to contact them to obtain details of their gap cover arrangements.