Gap cover doctors

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 plus health fund benefit. Unless your health fund has a gap cover arrangement in place with your doctor which will cover all of your doctor's charge, you will have to contribute towards the doctor's bill out of your own pocket.

It is important that you contact your health fund before you receive hospital treatment, where possible, to check whether your doctor is participating in the fund's gap cover arrangements. You should also ask your doctor(s) how much you will have to pay over and above your insurance cover. It is up to the doctor to decide on a case-by-case basis whether he or she wishes to use a fund's gap cover arrangement.

Some funds have specific information on their site, or you may have to contact them to obtain details of their gap cover arrangements.