Let`s go into a little more detail. If you are being treated in a hospital, an “expected fee” is charged, as described in the Medicare Benefit Schedule (MBS) for each different Medicare item number. Medicare and private health insurance cover 100% of these planned costs as well as accommodation and theater costs, provided you are treated in a hospital that has an agreement with your health insurance fund. If you want to charge the patient a higher discount amount than indicated in the fee schedule of the health fund, you should instead create a health fund: private invoice or Known Gap invoice (depending on your agreement with the health insurance company concerned). We understand that the Royal Australasian College of Surgeons (RACS) urgently advises against causing fees to patients while claiming a No Gap discount as part of your health insurance agreement. Depending on your health insurance agreement, AHSA funds can calculate the variance fee (expense fee) per item and not per invoice. While all insurers have gap agreements, there can be a big difference between what they set their thresholds. Take for example the non-gap threshold of a health fund for the surgeon`s fees for a knee replacement, which has a MBS fee of 1318 $US: it is also important to note that if your mutual has an agreement with a particular doctor, it is usually up to that doctor to participate in the Fund`s program on a case-by-case basis. It`s always a good idea to confirm with your doctor before asking if they will participate in the program for your specific situation. However, if you charge a know-how gap invoice as part of your health insurance agreement, we understand that the right may be denied or severely underpaid if you set a higher variance fee than you can charge under your agreement.
Some health insurers have entered into agreements with certain hospitals and doctors to reduce your expenses. There are different types of gap coverage systems, some examples are as follows: health funds have entered into agreements with some doctors who have agreed to calculate up to the threshold for some or all of their patients. . . .