Informed Financial Consent
Before you receive treatment you are entitled to ask your doctor, your health fund, and your hospital about any extra money you may have to pay out of your own pocket. This is commonly known as "the gap" payment. Knowing how much your treatment will cost is called Informed Financial Consent.
You are entitled to ask your treating doctor or specialist how much their fee will be, and if you will need to pay a gap. For major procedures you may request this in writing.
You may have several specialists, physicians or other doctors involved in your treatment for example a surgeon and anaesthetist. Your surgeon should be able to advise you who else will be treating you and how you can contact the other doctors to seek fee information from them.
You may have lower or no out of-pocket expenses if your treating doctor elects to use your health fund's gap scheme.
Ask your health fund whether your policy will cover the procedure, and whether you will need to pay an excess, co-payment or any other charge associated with the treatment.
Ask the hospital whether they have an agreement with your private health fund and whether you will have to pay any gaps or extra costs. The hospital will perform a membership eligibility check with your health fund before you are admitted and seek your informed consent to incurring any out-of-pocket costs associated with your admission. this information should be provided in writing.
If your bill is much higher than expected, you should check to see if you agreed to these charges before treatment, and contact your doctors office to discuss the reasons for the various charges.
If you are unable to negotiate a suitable outcome with your doctor, you may wish to contact the Private Health Insurance Ombudsman on 1800 640 695 for further assistance.