A ‘medical gap’ is any out-of-pocket expense incurred by a patient for their medical treatment during their stay in hospital. This reflects the difference between the total fee charged by the doctor and any Medicare rebate plus health fund benefit. Our surgeons have a gap cover arrangement with the following health funds in place which will cover all of your surgeon’s charge*, you will not have to contribute towards the surgeon’s bill out of your own pocket.
Unfortunately Latrobe Health services does not have a No Gap scheme. As such there will be a gap charged to equalise the amount to that paid by ALL other health funds.
From 1 July 2021 – There will be a change to medicare items numbers resulting in a significantly decreased payment, therefore we will not be able to continue to be wholly No Gap. Any ventral, incisional, umbilical or recurrent hernia operations performed on or after 1 July 2021 may have a gap associated. We will obtained full financial consent and provide you with a detailed breakdown of costs prior to your surgery. Inguinal hernias both primary and recurrent will continue to be charged at No Gap.
Please see the list below which provides more details on gap cover by each health fund
Terms and conditions:
*Some anaesthetists do charge a gap.
*Australian Unity Has no gap cover scheme for Members on Basic Hospital (B1, YB2), Smart Start (LB), Care ‘N Share (BA), Budget Hospital (B2), Basic Starter (YCA) and Basic Saver (YCB)
*Frank Health insurance without extra gap cover will have a gap payment charged.
*Combined Cases (involving multiple surgeons eg plastic surgeons) may incur a co-payment. This will be discussed with you and full financial consent obtained before your procedure.
*You may have a health fund excess depending on your policy.
*Some anaesthetists do charge a gap.
*From 1 July 2021 there may be a gap payment required for incisional, ventral, umbilical or recurrent hernias. (Not including inguinal)
