Simplified billing process / access gap cover
- How to get the most out of your private hospital insurance
- What is access gap cover?
- How does access gap cover work?
- How do I know if my specialist participates with CUA Health?
- What do I ask my specialist?
- What about other specialists involved in my procedure?
How to get the most out of your private hospital insurance
The federal government is making private health insurance even better value.
The on-going 30% government rebate has made private health insurance affordable for more Australians, while lifetime health cover rewards people who take out private hospital insurance early and keep it.
But one thing that has worried people about their health insurance is the gap left between the cost of doctors' services in hospital not covered by Medicare and their private insurance. The access gap cover scheme aims to change all that...
What is access gap cover?
CUA Health can now provide cover that can help you avoid the gap when you go into hospital - at no added cost to you. Under the access gap cover scheme, CUA Health can pay any gap amount for you - making your CUA Health health cover even better value.
Talk to CUA Health to make sure your policy includes this kind of cover, and to find out how to use it in case you ever need to go to hospital or day surgery.
How does access gap cover work?
CUA Health and specialists are now entering into arrangements that mean when you go to hospital or day surgery, you can receive doctors' services with no gap to pay.
In many cases, your specialist will agree to provide your treatment with no gap for you to pay. This means that Medicare and CUA Health will cover the total cost of doctors' services in hospital, and you won't have to pay any extra from your own pocket.
But while the majority of doctors' services in hospital are already gap-free, it is important to know that not all specialists are participating in the scheme, and not all specialists will have an arrangement with CUA Health.
There are cases where your specialist will decide to charge you a gap, even when he or she has an arrangement with CUA Health. However, your specialist should let you know - before treatment - what the gap amount will be. This is called a "known gap" and it helps take the surprises out of hospital treatment costs.
How do I know if my specialist participates with CUA Health?
There are several ways. When your GP first talks with you about referring you to a specialist, ask to be referred to a specialist who usually provides the treatment in a hospital you prefer with no gap to pay for CUA Health members. If your GP is not sure which specialists do this, he or she can phone CUA Health or the specialist to check.
Or your GP can give you the details of some suitable specialists and you can call CUA Health and check if the specialists usually provide hospital treatment with no gap to pay.
Alternatively, you can check with the specialist before you make an appointment.
What do I ask my specialist?
At your first consultation with the specialist, you should ask if he or she will be providing your treatment in hospital with no gap for you to pay. If, after your consultation, your specialist decides he or she is unable to provide you treatment with no gap for you to pay, ask what the gap amount will be. Remember, you are entitled to know how much you will have to pay from your own pocket.
At this point, you can choose to accept the amount they will be charging you. If you're not happy with the amount they will charge, you can ask your GP to refer you to another specialist.
What about other specialists involved in my procedure?
With any procedure, it is likely that there will be other doctors involved - such as an anesthetist, assistant surgeon, pathologist or radiologist. Because it is unlikely that you will see these doctors before your treatment, you should also check with the specialist if you will need to pay a gap for treatment provided by any of these other doctors.
For more information about access gap cover talk to CUA Health or visit the Australian Department of Health and Ageing website for more private health care consumer information.
