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HOME > ACCESS GAP COVER
The Access Gap Cover SchemeFor in-patient hospital treatment, Medicare will pay 75% of the MBS, and Westfund will pay up to 25% of the MBS. If you are treated by a doctor who charges above the MBS this will create an expense not covered by either Medicare or Westfund unless the doctor agrees to participate in the Access Gap Cover Scheme. Please note that radiology and pathology services are considered to be Doctors' Charges. The Access Gap Cover Scheme allows patients with hospital cover to eliminate or reduce out-of-pocket expenses for medical gap payments for in-patient hospital treatments. Westfund does not pay an amount charged by your doctor above the Medicare Benefits Schedule Fee unless your doctor agrees to participate in the Access Medical Gap Scheme. If a doctor does not use the Access Gap Cover Scheme, you will be responsible for any additional charges. Doctors are independent of Westfund and each doctor can choose on a case by case basis whether to participate in the Access Gap Cover Scheme. Please note that you should ask your doctor to explain the costs of your hospital admission including any prostheses gap amount, their own fees, any fees that other doctors involved in the admission (such as assistant surgeons and anaesthetists might charge, and any other expenses involved. If there are any gaps for you to pay, ask for a written cost estimate. This is known as 'informed financial consent'. The Access Gap AdvantageFinancial Certainty due to IFCIf your doctor charges you an out-of-pocket (gap) he or she should inform you in writing in advance of the treatment or as soon as practicable in cases of emergency. Under Access Gap Cover, you will receive a written quote or an estimate of medical fees from your doctor if there will be a gap. No claiming from Medicare and the Health Fund in most casesIn most cases, the doctor will bill Westfund directly and we settle the claim on your behalf. We even take care of the Medicare claim for you. Westfund will also send you a statement outlining all the benefits that have been paid on your behalf including the Medicare portion. Doctor Search FacilityYou can find a Doctor Search on this web site where you can search Doctor’s by name, specialty and/or area. This search facility is designed to inform you of doctors who have previously participated or have indicated their intention to participate in Access Gap Cover, as well as those who have agreed to alternative no gap arrangements. Patients are advised to be guided by the referral process initiated by their own doctor. Where you have been referred to a doctor and that doctor's name does not appear on this search facility, you should check with your doctor as to whether they would use Access Gap Cover for you. Doctor Patient RelationshipWestfund will not interfere in the autonomous relationship between you and your doctor. Frequently Asked Questions:How will I know if my doctor will participate?Doctors can choose whether to participate in Access Gap Cover on a patient-by-patient basis. It's important that you ask your doctor whether they will participate in Access Gap Cover for you.
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