As well as hospital fees, private patients in both public and private hospitals are charged fees by the treating doctor (and there may be more than one doctor for treatment such as surgery). Medical fees are covered up to the government recommended schedule fee, with Medicare covering 75% of the schedule fee and private health insurance covering 25%.
Many doctors charge above the schedule fee, and the patient must pay the extra (this additional payment is called the gap). Patients should check with their doctors what fees will be charged.
In some cases, private health insurers, private hospitals and doctors have established agreements that mean there are no gap payments, or gap payments that are known in advance, for patients being treated in some private hospitals. Patients should check whether their private insurer has any such agreement, and whether there will be additional expenses in the hospital where they are planning to be treated.
Gap cover schemes
Many private health insurers offer gap cover schemes. They may be included as a standard in hospital cover, but patients should check whether their insurance includes a gap cover scheme.
Details of gap cover schemes are available at the PrivateHealth.gov.au site.
The content of the Law Handbook is made available as a public service for information purposes only and should not be relied upon as a substitute for legal advice. See Disclaimer for details. For free and confidential legal advice in South Australia call 1300 366 424.