Your doctor, specialist, surgeon, anaesthetist, pathologist or radiologist all charge separately for medical services provided to you whilst you are a private patient in hospital. These are your medical expenses and, where eligible, these expenses will be assessed against the Medicare Benefits Schedule (MBS) fees. When you are an inpatient, Medicare will pay a benefit of 75% of the MBS fee. The fund then pays the remaining 25% of the MBS fee.
The MBS fee is the amount set by the Government for each medical service covered by Medicare.
Simplified Billing Agreements
Doctors can charge more than the MBS fee and often do. This could result in significant out-of pocket costs to you. Simplified Billing agreements are designed to reduce or avoid these extra costs.
Once the procedure has been completed the doctor will forward their account directly to the Fund for processing. We will claim the Medicare benefit on your behalf, then send this along with the Fund benefit directly to your doctor.
You may still have out-of-pocket costs if your doctor charges more than our benefit amount. An extra benefit will be paid by the Fund above the MBS fee. The rate paid varies according to the type of procedure. Ask your doctor for a quote and we will inform you if there is an out of pocket cost that your provider may be charging above your refund amounts.
No Gap Medical Benefits
Mildura Health Fund has entered into a ‘no gap’ agreement with a number of doctors and health service providers who operate at Mildura Health Private Hospital. If they are on a ‘no gap’ agreement, they have agreed to use our medical gap cover and do not charge our members an out of pocket amount gap. Your health service provider will bill Mildura Health Fund directly and you will pay nothing.
For a current list of health service providers who have a 'no gap agreement' with us please click here.