Bupa Medical Gap Scheme FAQs
What is the Bupa Medical Gap Scheme?
The Bupa Medical Gap Scheme is designed to reduce the medical costs you need to pay for treatment when you’re admitted to hospital. If your doctor or specialist uses our scheme, you’ll never pay more than $500 per doctor or specialist.
From 1 August 2018, your doctor(s) can choose to use the Bupa Medical Gap Scheme for your admission as a private patient in a public hospital, or in a private hospital with which Bupa has an agreement. This applies to each doctor involved in your treatment.
For more information on the Bupa Medical Gap Scheme, please visit: https://www.bupa.com.au/medicalgapscheme
How will the Bupa Medical Gap scheme work in public hospitals after 1st August 2018?
From 1 August 2018, for each doctor who chooses to use the Bupa Medical Gap Scheme in public hospitals for your admission as a private patient, the Bupa Medical Gap Scheme will work in the following way:
- If you have a pre-booked admission, you may be charged up to a limit of $500 by that doctor while you’re in that hospital.
- If you are admitted any other way, such as through the Emergency Department, you will not be charged for that particular treatment by that doctor while you’re in that hospital.
You will continue to be able to choose your doctor, whether or not your doctor chooses to participate in Bupa’s Medical Gap Scheme for your admission.
What does this mean for me in a private hospital, or a day stay hospital after 1st August 2018?
From 1 August 2018, the Bupa Medical Gap Scheme will only be available for doctors to use for your admission in private hospitals which have an agreement with Bupa.
Over 96% of all private hospital beds across Australia have an agreement with Bupa. If you’re treated at a private hospital without an agreement with Bupa, we will still cover some of your medical costs. However, you may incur additional costs depending on what your doctor decides to charge.
To see which hospitals have an agreement with Bupa, visit bupa.com.au/find-a-provider.
It’s always important to ask each doctor involved in your treatment up front about what costs they may charge you, and if they will use the Bupa Medical Gap Scheme for your admission. This is called Informed Financial Consent, and will help you understand what out-of-pocket costs you may have to pay
What is Informed Financial Consent?
Informed Financial Consent (IFC) is the provision of cost information to patients, including information about likely out-of-pocket expenses (also known as gaps), by all doctors involved in a patient’s treatment, prior to admission to hospital or treatment.
We encourage you to speak to all doctors (from surgeons to anaesthetists) involved in your health care to make sure you understand what costs you may have to pay. Where practical, it is preferable to receive such cost information in writing before your treatment.
Will I still be able to choose my doctor in a public hospital after 1st August 2018?
Whether your doctor chooses to participate in the Bupa Medical Gap Scheme or not, you will continue to be able to choose your doctor.
However, it’s important to check with each doctor involved in your admission what costs they may charge, and ask if they use the Bupa Medical Gap Scheme for your treatment. This is called Informed Financial Consent and will help you understand what out of pocket costs you may have to pay.
How do I know if my doctor uses the Bupa Medical Gap Scheme?
You can check which doctors use the Bupa Medical Gap Scheme at bupa.com.au/find-a-provider. However, doctors can choose whether or not to use the Bupa Medical Gap Scheme in your particular case.
We encourage you to speak to your doctor(s) about this; it’s important to check what costs they may charge, and ask if they will use the Bupa Medical Gap Scheme for your treatment. This is called Informed Financial Consent and will help you understand what out-of-pocket costs you may have to pay.
What can I do if my doctor doesn’t use the Bupa Medical Gap Scheme?
We believe that as a customer you should remain in control of your choices, including the relationship with your doctor(s) and how much you agree to pay for medical treatment.
If your doctor chooses not to use the Bupa Medical Gap Scheme for your treatment they can decide what they charge you and if they charge more than the Medicare and Bupa benefit which is the amount set by the Government (known as MBS benefit) then you will have a ‘gap’ or additional amount you will need to pay the doctor.
It’s important to check what costs your doctor(s) may charge for your treatment. This is called Informed Financial Consent and will help you understand what out-of-pocket costs you may have to pay.
What does this mean for regional and remote hospitals?
The Bupa Medical Gap Scheme is available for doctors to use in all public hospitals, and private hospitals that we have an agreement with, across Australia.
What happens in an emergency if I’m asked to provide my private health insurance details?
You should make this assessment based on your view of what is best for your personal circumstances.
You are under no obligation to use your private health insurance in a public hospital, and you should be aware if you do elect to be a private patient in a public hospital you should get to choose your treating doctor.
What happens in an emergency; do I get to choose my doctor?
Generally, if you are treated as a public patient you will be treated by the most appropriate doctor available at the time in an emergency.
If you elect to be treated as a private patient, you can choose your doctor; we recommend you raise this with hospital staff at the time of admission.
If you choose your own doctor (s), it’s important to ask up front about what costs they may charge you, and if they will use the Bupa Medical Gap Scheme for your treatment. This is called Informed Financial Consent, and will help you understand what out-of-pocket costs you may have to pay.
When will I hear more about this?
We will be communicating directly to all our customers with policies that include Hospital Cover before the changes come into effect on 1st August 2018.
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