If you have private health insurance, you should seek information about what your private health fund will cover and what you may have to pay yourself (the gap). Before you contact your health fund, please ask your doctor or provider about:
the most likely Medical Benefits Scheme (MBS) item number to be used
the name of the hospital or facility where the procedure will be performed
the charges of all attending doctors
the charges for tests, such as pathology or x-rays.
With this information, contact your health fund to ask about the full costs and any gap that may apply. The gap is the difference between what the practitioner charges and what Medicare plus your health insurance will actually cover you for. It is often called your ‘out of pocket expenses’.