Top tips for planned surgery

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We get it. Going to hospital can be stressful. 

To make your life easier, we’ve got some tips to make your planned surgery go smoother.


Tip 1. Select your specialist

You know the drill. You go to your local GP who may refer you to a specialist (say, a surgeon for example). 

Here’s something new though: Before you go to see a specialist, use our provider search.


At this point, you can choose your specialist based on how often they participate in our scheme to reduce your out-of-pocket expenses, called Access Gap. Our search tool gives you the choice of specialists in your area and puts the power in your hands.

Here’s one more reason to feel reassured that choosing a doctor based on their out-of-pocket expenses history is a good decision:

Doctors fees don’t necessarily have any relationship to the quality of treatment you receive.*

So, there’s often no reason to pay more.

How much can you save?

Government statistics show that members using gap cover agreements, like our Access Gap, reduce the average gap per service from $107.84 to $8.61.^ That’s a saving of nearly $100 per service. 

Now that we’ve got your attention (and a way to keep your cash in your wallet!), we’ll show you how to use Access Gap.

First you need to ask your doctor to bill you using Access Gap. If they do, we pay them more than the Medicare Benefit Schedule fee – resulting in lower or no out-of-pocket expenses for you. 

The provider search is available here Need some help using it? A step-by-step guide is available here

*Department of Health, Ministerial Advisory Committee on Out-of-pocket Costs, November 2018

^Private Health Insurance Medical Gap Statistics December 2018, Table 10, Australian Prudential Regulation Authority


Tip 2. Get an itemised quote off your specialist

You’ve done the right thing and chosen your specialist wisely. Now is the time to get the most important document of your entire surgery – an itemised quote called ‘Informed Financial Consent’.

Informed Financial Consent should include all Medicare Benefit Schedule items you’ll be receiving in your surgery as well as quotes from any other specialists who’ll be assisting the surgery, such as anaesthetists. It’s the only way your health fund (that’s us) will be able to tell you if you’re covered in hospital. So, it’s the key piece of the whole health fund puzzle. 

Plus, you’ll get the assurance of using the document to chat to us to get an idea of your full out-of-pocket expenses (if any). That’s next.


Tip 3. Call us on 1800 808 690

A simple call could save you time and angst. And we’ll be able to tell you:

  • whether you’re covered for your hospital admission. (If we’re unsure, we’ll ask you for Medicare Benefits Schedule items included in your surgery.)
  • your excess to pay (if any)
  • how to use Access Gap to reduce your out-of-pocket expenses
  • if you might be suitable for a hospital substitution program
  • if your contact details with us are up to date 

That’s a quick one. 


Tip 4. Don’t buy the gloom

You may have heard stories about outrageous out-of-pocket expenses people have paid to surgeons and anaesthetists in the news. 

And while these things do happen, the latest government statistics show that 87.7% of in-hospital services are gap-free.*

So, if you’re looking for value in private hospital cover, it’s still there if you need to go to hospital.


Proportion of services with no medical gap in Australia:

  • December 2018: 87.7%
  • December 2017: 88.1%
  • December 2016: 85.6%
  • December 2015: 86%


Just give us a call before your planned surgery to check if you’re covered and we’ll give you all the help we can to reduce your out-of-pocket expenses.

*Private Health Insurance Medical Gap Statistics December 2018, Table A, Australian Prudential Regulation Authority


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