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GU Health Medical Gap network

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Even with the most comprehensive hospital cover, you could still incur expenses when it comes to your in-hospital medical bills. This is where the GU Health Medical Gap network can save you money.

If your doctor participates in the GU Health Medical Gap network it could mean that your potential expenses will be reduced, or in many cases, eliminated completely.

Look for a GU Health Medical Gap network specialist in your area.

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How does the GU Health Medical Gap network work?

The GU Health Medical Gap network seeks to reduce or eliminate ‘the gap’, resulting in no or fewer out-of-pocket costs to you. It also recognises the right of medical practitioners to exercise their own clinical judgment.

Set schedule of fees

We offer a set schedule of fees for medical practitioners.

GU Health Medical Gap network

By participating in the GU Health Medical Gap network your doctor may accept the GU Health scheduled benefits as full payment for your treatment.

‘No Gap’ experience

Where this is the case, doctors will directly bill GU Health and you won’t have any out-of-pocket expenses. This is known as a ‘No Gap’ experience.

Set schedule of fees

We offer a set schedule of fees for medical practitioners.

GU Health Medical Gap network

By participating in the GU Health Medical Gap network your doctor may accept the GU Health scheduled benefits as full payment for your treatment.

‘No Gap’ experience

Where this is the case, doctors will directly bill GU Health and you won’t have any out-of-pocket expenses. This is known as a ‘No Gap’ experience.

Alternatively, your doctor may also choose to participate but charge an amount above the GU Health scheduled benefit – in which case they are obliged to provide, in detail, what the charges will be and what will be covered by Medicare and GU Health.

Known as ‘Informed Financial Consent’, this ensures you will know in advance of having the treatment exactly what your out-of-pocket expenses will be. This may still reduce your medical gap and is called a ‘Known Gap’.

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If your doctor or specialist elects to charge the GU Health scheduled fees and chooses to charge a ‘Known Gap’, you will have a guaranteed maximum Known Gap of no more than $400 to pay. This means you will only pay the $400 Known Gap once per claiming provider, per claim.

If they aren’t already participating in the GU Health Medical Gap network, ask your doctor to register. Doctors and other medical providers can register here.

Read more about the GU Health Medical Gap network

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From time to time the amount paid to specialists under the GU Health Medical Gap network will change.

Usually a review will see the payments increase, however if we reduce the amount a specialist will receive for a procedure under the Medical Gap network, we'll provide prior notice of the change on our website, as well as written notice to any member who has claimed for an affected procedure in the two years before the change occurs.

Other changes outside our control, such as changes to the MBS, may mean we’re not able to provide notice in this form.

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Going to hospital?

We’re here to help. Learn everything you need to know about going to hospital as a GU Health member.