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Women Unnecessarily Forking Out Millions in Gap Fees

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Australians forked out $158 million in medical gap fees in the first quarter of 2014[1], despite having private health insurance. A leading comparison service says this figure suggests that Australians are not aware that gap fees can largely be avoided or at least reduced by using doctors that have a gap cover agreement with their health fund. The need to avoid gap fees is especially important for women, who typically require a wide variety of health services during their lifetime.

Patients face a ‘gap’ fee when healthcare providers charge more than the Medicare Benefits Schedule (MBS) fee. For in-hospital care, Medicare covers 75 per cent of the MBS fee, while your health fund will typically pay the additional 25% (as long as you’re eligible for that particular benefit).

Abigail Koch, spokesperson at insurance comparison service comparethemarket.com.au, says as women tend to have a wide range of healthcare needs, they need to do their homework to avoid gap fees. To make sure they get the most out of their policy, they should also look at matching their specific healthcare requirements to their particular life stage.

“The first step is to seek healthcare providers with gap cover agreements from the list provided by your health fund. Take the time to get detailed costs from your doctor before any procedure, to make sure they’re on par with the Medicare Benefits Schedule fee. Additional medical practitioners such as anaesthetists also need to be listed on this agreement,” said Abigail.

With many unaware of the potential costs that they may face, comparethemarket.com.au outlines ballpark fees attached to basic female in-hospital and outpatient services.

Pap smear

IVF or fertility treatments

Pregnancy and birth (in patient)

Mental health

Menopause and hormonal conditions

Joint replacement

[1] Australian Government Quarterly Gap Payment and Medical Benefits Statistics March 2014

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