Health Partners Access Gap Scheme

About the Access Gap scheme

Health Partners Access Gap Scheme is designed to lower or eliminate your specialist’s bill for an in-hospital procedure.

We have arrangements with thousands of medical specialists Australia-wide who have agreed to either charge:

• No out-of-pocket cost, or
• A reduced amount for medical procedures.

Access Gap also provides a simpler billing process for you and your specialist.

It's a specialist's choice to use Access Gap on a patient-by-patient basis. You should ask them directly if they (and any assisting doctor/specialist) will use it for your procedure and if any out-of-pocket costs apply.

How does Access Gap work?

Medicare sets a standard fee for all medical and hospital procedure item numbers, called the Medicare Benefits Schedule (MBS) fee.

The MBS fee is a pre-determined fee that the Government considers appropriate for each procedure.

When admitted to hospital:

• 75% of the MBS fee for your procedure is paid by Medicare
• 25% of the MBS fee for your procedure is paid by Health Partners

In Australia, specialists are able to set their own fees, and these fees can vary significantly. When a specialist sets their fee higher than the MBS fee, it creates an out-of-pocket cost (also known as a gap payment), which you’ll need to pay.

With Access Gap we have set fees for procedures that are higher than the MBS fee schedule. It’s up to your specialist as to whether they’ll apply the Access Gap pricing to your procedure.

If your specialist uses Access Gap you’ll either have:

• no out-of-pocket cost, (similar to bulk billing) or
• a reduced amount which will be disclosed upfront, prior to your procedure.

How to find an Access Gap specialist

• Call us on 1300 113 113
• Use our Specialist Search tool

If they’re not listed, it doesn’t mean that they won’t use Access Gap. It’s your specialist’s choice to use Access Gap on a patient-by-patient basis. You should ask them directly if they (and any assisting doctor/specialist) will use it for your procedure.

Before your procedure:

• Ring the specialist’s practice to check if they use Access Gap
• Ask whether they will apply Access Gap to your situation
• Have them quote you in writing the amount they’ll charge you if any.

Access Gap bills

If your specialist participates in Health Partners Access Gap Scheme, you probably won’t need to do a thing. They’ll send the bill directly to us. Once we’ve paid it, we’ll send you a quarterly statement to let you know what we’ve paid on your behalf. If they charge a gap, you’ll need to pay this directly to them, in most cases before your planned surgery.

The information contained here is of a general nature and does not take into account your personal medical situation. The information is not a substitute for independent professional medical advice and is not intended to diagnose, treat, cure or prevent any disease or used for therapeutic purposes. Should you require specific medical information, please seek advice from your healthcare practitioner. Health Partners does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information provided.