Also called out-of-pocket cost.
The amount you pay when your specialists charge more than what Medicare and your health fund can pay.
For example, as a private patient in a hospital or a day surgery centre your specialists who treat you will each raise a bill for their services. The Australian Government sets a schedule of fees for all medical treatments called the Medicare Benefits Schedule (MBS).
For items on the MBS, Medicare covers 75 per cent, while your health cover pays up the remaining 25 per cent. However, some specialists charge more than the MBS fees, with the extra amount referred to as the ‘medical gap’ or your out-of-pocket cost.
RBHS has Access Gap, a scheme to reduce your out-of-pocket specialist expenses. First you need to ask your specialist if they participate. If they do, we pay them more than the Medicare Benefit Schedule fee – resulting in lower or no out-of-pocket expenses for you.