Provider search

1. Use the search tool above and search for practitioner by specialty or name. A dropdown will appear once you begin typing. 
2. Choose your preferred option while browsing the list of providers. 
3. You'll be able to see the provider's contact details and get directions from your location.

Once you have chosen your specialist, ensure they supply you with an informed financial consent document. This document provides you with an estimate of fees for the proposed treatment and should indicate the medical gap or out-of-pocket expenses.

Please contact GMHBA prior to your treatment to discuss any medical gap that may apply for your procedure.

What is a medical gap fee?

Medical gap fees (also known as out-of-pocket costs) are the difference between the amount that GMHBA and Medicare can pay and what a doctor charges for their service. Healthcare providers set their own fees, so you should always get a written estimate of fees from your specialist, the hospital, the anaesthetist and anyone else involved in your treatment (known as Informed Financial Consent). Learn more about hospital fees and charges. 

What is the Access Gap and Known Gap?

The Australian Health Service Alliance (AHSA) Access Gap Cover scheme is a billing system that provides higher benefits than the Government’s scheduled fee. It is designed to reduce or even eliminate any gap for medical fees for private patients being treated as an inpatient in hospital or patients receiving hospital-substitute treatment.

Specialist doctors who are registered for, and choose to use, the Access Gap Cover scheme get a higher benefit from GMHBA (more than the standard 25%), in exchange for limiting the gap they charge to you.

There are two scenarios for how you may be billed by your specialist doctor when they use the Access Gap Cover scheme:

• No Gap – this is where there will be no gap for you to pay following the procedure
• Known Gap – this is where you will be charged a maximum gap of $500 per doctor, per episode. This excludes obstetricians who can charge up to $800 per confinement for management of labour and delivery.

If you choose a doctor that does not participate in the Access Gap Cover scheme for your procedure, you will still be covered by Medicare and GMHBA for the scheduled fee, but will need to pay any gap.

You may also receive services from an assistant surgeon and anaesthetist for your procedure – they can also choose whether or not to participate in the Access Gap Cover scheme. You may have separate gaps to pay for their services.

Before deciding to have a procedure, you should discuss the cost of treatment with your specialist doctor. Your specialist must advise of any gap that you will have to pay and provide a written estimate of the fees for treatment, before you go into hospital.

The health provider you choose must be registered in their field, in private practice and recognised by GMHBA (annual limits and waiting periods apply).

While Medicare contributes towards things like GP, care plans and the public hospital system, extras cover in Australia offers people the choice to be covered for a broader range of services that Medicare don’t typically cover.

With most providers, you’ll be able to claim at the time of the appointment, by swiping your membership card so that GMHBA can pay the benefit directly to the provider and you just pay the difference. If your provider does not have the means to accept electronic claims at the point of service, then you will be required to pay the bill in full and then submit a claim directly to GMHBA to receive eligible benefits.