Common questions about Medical Gap
Following are the answers to some frequently asked questions on MBF Medical Gap Cover. Please remember we recommend that you speak with your general practitioner. They are in the best position to refer you to a specialist that will meet your clinical needs.
Check with your specialist as to whether they will use the MBF Schedule of Fees for your in-patient hospital services.
Remember, MBF Medical Gap Cover is available
- Where normal membership conditions are met. e.g: Your waiting periods have been served.
- Medicare pays an in-patient hospital benefit
- Your doctor agrees to participate
- When your MBF membership includes hospital cover
What is the medical gap?
When in hospital, the 'medical gap' is the amount above the Medicare Benefits Schedule Fee that some doctors charge for medical services. Traditionally, the 'medical gap' was not covered by health funds.
How does MBF Medical Gap Cover work?
If you have medical treatment in-patient hospital, your doctors can choose to participate in MBF Medical Gap Cover. When they 'opt in' you will have no 'medical gap' to pay for the treatment provided by that particular doctor.
What if my doctor is interested in providing me with medical gap cover but hasn't contacted MBF?
All MBF members who have chosen any MBF HealthSmart product, MBF FamilyFirst or other MBF hospital cover will find medical gap cover is included automatically. There is no need to buy any additional products.
Ask all doctors involved in your hospital care if they are registered as MBF Medical Gap Cover providers. "No gap" doctors are those who accept the MBF Schedule of Medical Fees as full payment for your in-patient hospital medical services. The majority of doctors around Australia have been sent a copy of the MBF Schedule of Medical Fees and have the option of using it.
Click here to find out if your radiology or pathology (diagnostic) provider has entered into an arrangement with MBF, or call MBF on 131 137, to find further information regarding MBF Medical Gap Cover.
How do I find an MBF Medical Gap Cover Specialist?
Your general practitioner is in the best position to refer you to a specialist that will meet your clinical needs. The MBF Schedule of Medical Fees is available to all doctors for in-patient hospital services. Under our scheme, doctors can choose on a patient-by-patient basis whether or not to charge fees according to the MBF Schedule.
If they do, MBF will fully cover those fees. The result ... No medical gap where doctors agree to participate in MBF Medical Gap Cover on a patient by patient basis.
By calling MBF on 131 137 we can provide more information on MBF Medical Gap Cover specialists.
What are the benefits of MBF Medical Gap Cover?
- Financial certainty of "no gaps" for in-patient medical services received in-hospital where your doctor opts in.
- Simplified claims process. You do not have to make the claim.
- Improved value from your private health cover.
What do I need to do if I'm going to hospital?
Call us before you go to hospital and we'll confirm whether each of your doctors are registered for MBF Medical Gap Cover. If they are, ask whether each of them will use MBF Medical Gap Cover for your in-patient hospital service.
MBF can advise you of specialists who are registered for MBF Medical Gap Cover.
Remember, you can also ask your GP to refer you to a specialist offering the financial certainty of medical 'no gap'.
If I confirm the doctor is registered how can I be sure he or she will give me "no gaps"?
As doctors can choose to use the MBF Schedule of Medical Fees on a patient-by-patient basis we cannot guarantee that the doctor will offer "no gaps" in all cases. You will still need to ask your specialist if they offer "no gaps" for your episode of care.
Every doctor has the option, on a patient-by-patient basis, of choosing to participate for that particular patient or not. This means that every doctor can offer "no gaps" if they choose, but no doctor is obliged to do so.
MBF Medical Gap Cover is available from doctors throughout Australia who register to use the MBF Schedule of Medical Fees.
Will my family doctor know which specialists offer "no gaps"?
Your family doctor is best placed to refer you to an appropriate specialist for the health care you require. Ask your family doctor if the specialist you are being referred to offers "no gaps" or alternatively contact MBF by calling on 131 137. In most cases, we can confirm whether the specialist you have been referred to is registered for MBF Medical Gap Cover.
It is important to note the MBF Medical Gap Cover arrangement is optional on a patient-by-patient basis. You will need to ask your specialist if they will use MBF Medical Gap Cover for your in-patient hospital episode.
What happens to the doctor's invoice?
Your doctor will either send the invoice to you (with the MBF Medical Gap Cover claim form attached) or they will send it directly to MBF. If the doctor does send it to you, forward it on to MBF immediately, not Medicare. We will arrange for the Medicare portion to be paid on your behalf. In the majority of cases, you will not be forwarded the doctor's invoice.
The whole amount is then sent to your doctor for you. We will send a statement to you showing what we have paid the doctor.
You should not pay anything further to that doctor for that in-hospital treatment.
What if my doctor is interested in providing me with medical gap cover but hasn't contacted MBF?
Ask your doctor to e-mail dr.billing@mbf.com.au, ring 1800 111 623 or fax 1300 653 623. It is a simple matter of registering and MBF will send out a billing kit to the doctor. We would also be happy to contact the doctor directly to talk about how easy it is to offer MBF Medical Gap Cover.
Medical Practitioners who wish to participate can access the terms and conditions for participating doctors here, and E-mail dr.billing@mbf.com.au to obtain a copy of the MBF Schedule of Medical Fees.
