Charges and the gap

Understanding the cost of your hospital treatment will help you avoid unexpected bills. 

• Hospitals and the doctors who treat you bill separately for their services
• If your entitlements don’t cover the full cost of your treatment you’ll have to pay the difference, known as ‘the gap’
• We negotiate charge agreements with selected hospitals and doctors to help our members avoid out-of-pocket costs

Before any planned hospital admission, it’s wise to find out how much your treatment will cost and whether you’re covered for the full amount. This will help you avoid out-of-pocket expenses.

Hospital costs

Hospitals bill for accommodation, operating theatre and other hospital-related services.

We have agreements in place with many private hospitals (known as participating hospitals) to ensure our members won’t face a gap for services covered under their policies.

Going to a non-participating public or private hospital could incur additional costs. Being aware of these costs and consenting to them is known as Informed Financial Consent.

Wherever you’re treated, if you’re claiming for the first time that calendar year you may have to pay an excess – this will depend on the nature of the treatment and your chosen cover. Check your cover or call 13 13 34 to find out which level of excess you chose when you took out your policy.

Medical costs

Medical services (such as doctors’, anaesthetists’ or surgeons’ fees) are billed separately. These costs are shared between Medicare and your fund.

Medicare contributes a set amount for each treatment or procedure, as laid out in the Australian Government’s Medicare Benefits Schedule (MBS). For in-hospital treatment, Medicare pays 75% of the MBS fee; your insurer pays the other 25% (provided you’re covered for the service).

As many doctors charge more than the MBS fee, there may be a gap – our members can avoid this by going through the HCF Medicover scheme.

HCF members, and GPs, can search for Medicover no-gap (no cost to members) or known-gap (an agreed amount – capped at $500) doctors through Healthshare*. To access the search tool, go to Find a participating provider.

Watch ABC’s Four Corners report on out-of-pocket medical expenses from May 2018.