If you are a private patient in a public or private hospital, HCI pays benefits for treatment provided to you by a doctor whilst you are in hospital.  However, the Federal Government’s Commonwealth Medical Benefits Schedule (CMBS) specifies how much both Medicare and HCI pay for that treatment. Indicatively Medicare pays 75% of the amount specified in the schedule and HCI pays 25%.

If your doctor chooses to charge above the CMBS fee you may have to pay the medical gap or “out of pockets” which is the difference between the total fee charged by the doctor and the CMBS fee. HCI does not pay a benefit on out of pockets.

It is in your interest to discuss the issue of fees with your doctor to determine whether they will use HCI’s Access Gap Cover which will minimise or eliminate your medical out-of-pocket costs.

Should you ever need specialist care in hospital, your doctor can now provide a much simpler billing system by choosing to use HCI’s Access Gap Cover.

If your Doctor uses the scheme, you will either:

  • Have no out-of-pocket expenses; or
  • You will know exactly how much you will have to pay before treatment begins.

Also, your doctor can bill HCI direct, saving you from having to claim from Medicare and HCI yourself. It is your doctor’s choice to use Access Gap Cover. Your special relationship with your doctor and the treatment you receive will not change.

Questions to ask each Doctor…

  • Will you treat me under Access Gap Cover?
  • Will I have any out-of-pocket expenses, and if so, can you provide a written estimate of how much?
  • Will any assisting doctors also use Access Gap Cover and if so, how can I obtain a quote for their services?
  • Are you prepared to send the bill to HCI directly?

Use the search feature below to search for registered participating doctors.