Gap! Gap! Gap!

Everyone says 'Gap' like it's common knowledge and most of us just nod and hear circus music. What does 'Gap' actually mean? 

 Well, the government assigns an amount to be paid for every Medicare Benefits Scheme item number, (we insiders reduce this to MBS to save time).  

Providers are aware of the MBS and can decide to charge only the MBS amount, or they can add a Gap charge on top of the MBS amount. If they charge a Gap charge, then the patient is out of pocket.  

How do you avoid a gap charge?  

  • Ask your referring doctor to direct you to a 'No Gap' specialist.  
  • Search using our 'find a provider' tool on the Peoplecare website to discover what doctors are likely to offer 'No Gap' billing.  
  • 'No Gap' can apply to some items, but not others. Discuss this with your doctor.  
  • If the referred doctor doesn't offer 'No Gap' billing, get a second opinion.  

Your health fund and/or Medicare will only pay to the MBS amount, so it's important to understand any Gap charges before you wake up in recovery and have to sell a kidney. Ask your doctor for a full cost breakdown.  

So next time someone says 'Gap' in relation to your medical expenses, you know you need to research your options. Ask questions. Understand the process. Don't let your doctor hold you Gaptive.  

See what I did there?  

It's your health, know the answers before you count backward from 10. Ask all the questions that are playing on your mind.  

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Member give-back

As a not-for-profit and member-owned health fund, we’re committed to giving back claims savings we made due to COVID-19 restrictions. Members will receive their refunds in the same bank account that we pay their claim benefits to. Members don’t need to do anything to receive their refunds.

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