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How to avoid bill shock

Going to hospital for a medical procedure can be stressful enough, and the last thing you need is to worry about how much it’s going to cost.

Understanding how specialist fees work and implementing cost saving strategies at the start will help you avoid any nasty surprises when your bill arrives.

Here are our tips for avoiding bill shock.

Understand specialist fees and charges

Before agreeing to any procedure it’s important to understand how fees and charges work.

In Australia, specialists are able to set their own fees, and these fees can vary significantly.

Medicare sets a standard fee for all medical and hospital procedure item numbers, called the Medicare Benefits Schedule (MBS) fee. When you’re admitted as a private patient, Medicare will reimburse 75% of the scheduled MBS item fee they have set for each procedure, and Private Health Insurance, by law, can only pay the remaining 25%.

Many specialists choose to charge higher than the MBS fee. This means that after Medicare and Health Insurers contribute there’s still an amount owing. This amount is often referred to as an out-of-pocket cost or gap payment, which you’ll need to pay. Keep reading for some tips that can help reduce or even eliminate your out-of-pocket costs.

Ask your specialist for a quote

A quote outlining all of the costs involved in your procedure is a sure way to feel financially prepared for what’s ahead.

Your specialist should provide you with a written breakdown of all associated costs with your procedure, including:

  • MBS item numbers and fees – they’ll be your best indicator for what your out-of-pocket costs will be.
  • Fees of any other doctors involved, like an assistant surgeon or anaesthetist.
  • Costs for any prostheses and pathology.

It’s also a good idea to check if you’re being charged a booking or administration fee – often these fees aren’t valid and should be questioned. If you’re not sure, call us on 1300 113 113.

Before your specialist can book your procedure in, you’ll need to give informed financial consent, which means you understand and consent to all the charges in your quote.

How to reduce your costs

Medical costs can add up quickly. It’s a good idea to have the following strategies in place to help reduce your out-of-pocket costs.

1. Register for a Medicare Safety Net

If you think you’ll need regular doctor’s appointments (GP and/or specialist) and diagnostic tests, consider registering for the Medicare Safety Net.

It can be particularly useful if you have complications with a chronic or neurological condition, are undergoing cancer treatment or having a procedure that requires ongoing care.

When you (or your family) spend over a certain amount in a calendar year, Medicare will give you a higher amount back, lowering your out-of-pocket cost for doctor’s visits and diagnostic tests like x-rays and ultrasounds. They’ll still cost the same, but Medicare will give you a higher benefit back, so you pay less.

For more information, discuss the Medicare Safety Net with your GP or visit

2. Choose an Access Gap Specialist

Choosing a specialist who participates in the Access Gap Scheme is the best way to reduce or even eliminate your medical out-of-pocket costs.

Our Access Gap Scheme is designed to lower or eliminate your specialist’s bill for an in-hospital procedure.

We have arrangements with thousands of medical specialists Australia-wide, including anaesthetists, who have agreed to either charge no out-of-pocket cost or a reduced amount for medical procedures.

It’s important to ask your specialist upfront if they participate in the Access Gap Scheme and, if they do, will they apply it to your situation.

How can you find an Access Gap specialist?

  1. Call us on 1300 113 113
  2. Use our Specialist Search tool

3. Visit a Health Partners Participating Hospital

To help you save, we have agreements with most of Australia’s private hospitals. These agreements ensure that hospitals are charging a fixed amount. We’ll pay this amount in full on your behalf, meaning you’ll have no out-of-pocket cost for:

  • Accommodation including food and meals
  • Nursing and theatre fees including labour ward, intensive care and special care units
  • PBS medications related to your admission while in hospital (excludes your regular medications)
  • Government recognised prosthetics

How can you find a participating hospital?

  1. Call us on 1300 113 113
  2. Use our Hospital Search tool
  3. Ring the hospital direct and ask if they’re a participating hospital


For more information about reducing your medical costs, download and use our How to pay less for your procedure flyer.

How to pay less for your procedure flyer (PDF)

Going to hospital?

Use our Hospital Support service, it has everything you will need to know and do before, during and after hospital.

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