Hospital Support

If your specialist has chosen to participate in Health Partners Access Gap Scheme, you probably won’t need to do a thing.

They’ll send the bill directly to us. Once we’ve paid it, we’ll send you a quarterly statement to let you know what we’ve paid on your behalf. If they charge a gap, you’ll need to pay this directly to them, in most cases before the planned surgery.

This means you only need to pay the difference between what your specialist charges and what Medicare and Health Partners covers, rather than the full bill. This is generally paid to your specialist prior to surgery.

If your specialist sends the total bill directly to you, you’ll need to send it to Medicare first. There are two ways you can claim with Medicare:

1. Medicare Two Way Claiming
The easiest way to make a claim is to fill in a Medicare Two Way claim form. Once Medicare has processed the account, they’ll send everything directly to us, so you won’t have to worry about it.

2. Health Partners claiming form with a Medicare benefit statement
Claim with Medicare first using their process. Once you receive your Medicare benefit, you’ll need to send us your original bill, Medicare benefit statement and completed Health Partners claim form.

Tip: If you have an account with Medicare, you can download your Medicare benefit statement from myGov.

Review and gather all your information like quotes, dates, correspondences and any other documents you might have. Document as much as you can from your conversations with your specialist.

Question why your bill is higher than your agreed quote.

If your specialist can’t explain the increase, you’ll need to formalise your complaint by putting it in writing via email or mail. Summarise what’s happened and briefly state why you’re unable to pay the difference. The Commonwealth Ombudsman also recommends paying some of the bill i.e. what you thought you would pay.

If you’re unable to resolve the problem with your specialist, make a formal complaint with the Royal Australasian College of Surgeons (RACS). The RACS will investigate and determine whether the fees charged are excessive and help you seek a resolution.