If you are a private patient in a public or private hospital, HCi pays towards any covered treatment a doctor provides whilst you are in hospital.  However, the Federal Government’s Commonwealth Medical Benefits Schedule (MBS) specifies how much both Medicare and HCi pay for that treatment. Indicatively, Medicare pays 75% of the amount specified in the schedule and HCi pays 25%.

However, if your doctor chooses to charge above the MBS fee, you may have to pay the medical gap which is the difference between the total fee charged by the doctor and the MBS fee. HCi does not pay claims for out of pocket expenses.

It is in your interest to discuss fees with your doctor and find out if they will use HCi’s Access Gap Cover to minimise or eliminate your medical out-of-pocket costs.

If you ever need specialist care in hospital, your doctor can now provide a much simpler billing system by choosing to use HCi’s Access Gap Cover.

Finding providers and costs

If you are facing a procedure, it is always good to discuss your options with your current medical provider.

You can also find out about relevant providers in your area by using our specialist and hospital search tools below. Simply enter your postcode and search by name or speciality.

For a guide on what the procedure may cost you, the Federal Government’s Medical Costs Finder (MCF) could be a useful tool. It shows what the average price is nationally and per state. You can also see how much Medicare will cover and the likelihood of out-of-pocket expenses.

If your provider uses the scheme, you will either:

  • have no out-of-pocket expenses; or
  • know exactly how much you will have to pay before treatment begins.

Also, your doctor can bill HCi direct, saving you from having to claim from Medicare and HCi yourself. It is your doctor’s choice to use Access Gap Cover. Your special relationship with your doctor and the treatment you receive will not change.

Questions to ask each Doctor…

  • Will you treat me under HCi’s Access Gap Cover?
  • Will I have any out-of-pocket expenses, and if so, can you provide a written estimate of how much?
  • Will any assisting doctors also use HCi’s Access Gap Cover and if so, how can I obtain a quote for their services?
  • Are you prepared to send the bill to HCi directly?

Use the HCi provider search to search for registered participating doctors and health providers.

About the Hospital Search

HCi has agreements with most private hospitals that are likely to be accessed by members. These agreements ensure that an agreed schedule of fees (including in-patient accommodation, theatre and special unit accommodation fees as appropriate) is charged by the hospital and paid by HCi on your behalf. Please note your entitlements are affected by factors such as your level and type of cover, and the financial status of your membership. This will affect the amount HCi reimburses to the hospital.

HCi strongly recommends you contact us on 1800 804 950 to confirm your entitlement prior to receiving hospital treatment.

If you choose a non-agreement hospital, please note you may incur out-of-pocket expenses for hospital related services irrespective of your level of cover.

Please note that search results will include any private hospitals HCi has previously accepted contracts with, until HCi terminates a contract. Thus the search results will display information relating to a private hospital where the relevant contract is up for renewal but HCi has not yet decided whether or not to renew the contract. HCi uses its best endeavours to respond promptly to renewals so that search results are as accurate as is reasonably possible.