Access Gap

If a doctor charges you more than the Medicare Benefits Schedule (MBS), this amount is known as a ‘medical gap’. The RBHS has arrangements with more than 36,000 doctors Australia wide where additional benefits are payable by the RBHS to reduce or eliminate ‘medical gaps’ faced by members. This scheme is known as Access Gap.

Doctors may charge more than the Medicare Schedule Fee, leaving you with out-of-pocket expenses. Access Gap Cover allows the RBHS to pay above the schedule fee, potentially covering the entire doctor’s charge or leaving you with a significantly reduced out-of-pocket expense.

With Access Gap Cover, your doctor can bill the RBHS directly. If your doctor charges the Access Gap Cover agreed fee, you will have nothing extra to pay. If your doctor charges above the Access Gap Cover fee, you will be able to find out what gap you may have to pay before receiving treatment.

Doctors can choose to participate in Access Gap Cover on a patient-by-patient basis. In order to reduce the likelihood of paying medical gaps, it is important that you discuss Access Gap Cover with your doctor prior to the treatment.

Before admission to hospital you should ask your doctor/s to inform you of all medical fees that may be charged and whether they participate in our Access Gap scheme. If the doctor elects not to participate in the Access Gap scheme and charges a fee above the MBS, this additional amount will need to be paid by you. Before any hospital treatment, you should confirm all charges with your doctor/s. We can help you to identify whether your doctor participates in the Access Gap scheme. Simply call us on 1800 027 299, or you can look up your doctor via our search function here.

Please note that some doctors prefer not to be publicly listed. If the doctor you're looking for isn't listed on our website, contact them to find out how they'll charge you for your treatment.