Looking to close ‘the gap’? Medicover can help

We know that medical care (especially procedures) can be stressful, even frightening. That’s why we offer our members access to Medicover – a way you can reduce your out-of-pocket costs for medical services in hospital.

And that means you’re able to just focus on your treatment … and getting better sooner.

Why is there a gap anyway?

Out-of-pocket expenses (commonly called ‘the gap’) is the amount you pay over and above what you can claim from Medicare and from your private health insurer.

But if you’re with RT Health, we can help curb the costs by helping you locate doctors and surgeons who often participate in Medicover. This means they’ll treat you for a known cost.

It means that because you’re an RT Health member, you’ll get a clear outline of the costs involved (which are generally a lot less through Medicover).

It’s important to have a conversation with your doctor(s) and be fully informed about the costs before you go to hospital, as you are entitled to know how much your doctor(s) will be charging you. Where possible, ask for a written breakdown of expected costs. This is called Informed Financial Consent.

Medicover. What’s it all about?

For RT Health members, the best way to ensure you have no, or lower, out-of-pocket costs is to choose a doctor who participates in our Medicover program.

You make arrangements before you go into hospital and take the time to discuss the costs with your treating doctor.

When you’re referred to a specialist by a doctor, ask them if they can recommend someone who participates in Medicover. If the doctor is unsure about who to recommend, you – or the doctor – can search for a specialist via the ‘Find a Doctor’ link on our website or by visiting https://www.healthshare.com.au.

Medicover is just another way RT Health is committed to making sure our members get great healthcare (when they need it the most).

So, how does Medicover work?

If you’re admitted to hospital as a private patient, medical services - such as doctors’ fees - are charged separately to hospital accommodation and theatre fees. Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee and RT Health, as your private health insurer, will pay the remaining 25%. Doctors are not limited to only charging the MBS fee – and that’s where people can end up with out-of-pocket costs.

By using Medicover, you can reduce the likelihood of out-of-pocket costs. Doctors participating in Medicover will charge a set fee based on a different fee schedule agreed with the private health insurer (which may be higher than the MBS fee but probably not as much as they might otherwise charge). Part of this agreement is how much of the charge above the MBS fee will be covered by the insurer and how much will be payable by the patient as an out-of-pocket expense. By using a doctor participating in Medicover, you’ll either have no out-of-pocket costs or you’ll know in advance what the gap costs will be (written informed financial consent).

Find a doctor

Finding the right specialist for you is easy using the handy search tool. You can search by speciality, suburb, postcode or hospital. You’ll also find additional information, including languages spoken and hospital affiliations.

How can I arrange to be treated under Medicover?

Ask your doctor(s) if they will participate in RT Health’s Medicover program at the time you’re arranging your hospital treatment.

It’s important to know that doctors can choose whether or not to participate in Medicover on a case-by-case basis, so you’ll need to ask your doctor(s) if they are willing to participate each time you require hospital treatment.

It's also something that needs to be agreed with each doctor who will treat you in hospital, which means having separate discussions with your surgeon, anaesthetist, pathologist and so on.

Questions to ask your doctor:

Will you treat me under a Medicover arrangement?
Will I need to pay any out-of-pocket costs for my treatment? If so, can you give me a written estimate of how much I’ll need to pay?
How many other doctors will be assisting with my treatment and will they also participate in Medicover?

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