Do we no gap?

Medicare / Financing

17 Jan 2021

Do we no gap?

‘Do you no gap?’ is one of the most commonly asked question that we receive in the clinic.

The short answer is unfortunately no – the private health funds simply do not compensate surgeons, anaesthetists and other medical professionals adequately for us to be able to accept only a payment from them.

When the gap payment is often less than 30% of what the average surgeon is charging for plastic surgery in NSW, it is impossible to provide the 5 star care and results we are known for!

What is ‘the gap’?

What is referred to as the ‘gap’ is the difference between what Medicare and your private health fund will pay towards your medical treatment, and what your specialist surgeon or hospital charges. This is your out-of-pocket expense.  

Many health funds provide a great service to the community but as health costs rise across the population, and some funds try to make themselves more profitable for shareholders, they are putting pressure on doctors to accept, “no-gap” or “medi-gap” payments. It appears routine that members calling funds, after decades of paying premiums, asking why rebates are so low are told that the doctor should be accepting, “no-gap”. That is, they are pushing the blame back on the doctor.

Why isn’t the “no gap” payment enough?

The ‘no gap’ system is where the surgeon agrees to take a fixed fee from a private health insurer, similar to the American model.  While this can seem a positive for patients, in reality the fee the fund pays is simply not enough to run a modern plastic surgery practice like ours which is focused on exceptional clinical outcomes and award-winning care.

For example, let’s look at one of our most popular procedures – breast reductions. If we were to accept the “no-gap” fee which is around 30% of what the average NSW surgeon charges for a reduction, we simply could not afford the costs of running our practice including having registered nurses available for post-operative visits, quality post op garments and dressings, our award-winning reception team and overheads like practice insurance and electricity. Not to mention that Dr Moncrieff would not be able to spend the time in theatre that he does getting ‘wow’ results!

This is a widespread issue amongst medical providers and in desperation some providers choose to use­­ the ‘no gap’ system while also charging a patient a gap which is not disclosed to the fund. This is unethical and breaches the health fund contracts. So obviously we do not do this.

Gap payments also mean we have to chase money… sometimes for months!

Another issue with gap payments is the amount of time we have to allocate from our team to chasing the money from the funds. In the past this was almost a full-time role for someone when we had other surgeons who offered no-gap skin cancer surgery for retired patients.

Nowadays we prefer to focus the time of our team on helping patients – not being debt collectors!

So is it even worth having private health insurance?

This is a decision you have to make! It certainly helps with the cost of surgery like breast reduction or tummy tucks (abdominoplasty) where the fund will help cover the costs including the hospital. This can save almost $10,000 in the case of a tummy tuck.

More information about choosing a private health fund is here.

The main point to make it is that you need to check they will cover the exact Medicare item number for the procedure you are looking at. If not, they won’t help when it comes to the time of your surgery. Always make a note of the time and date you called and who you spoke to if you can’t get this information in writing!

We’re transparent about costs

We understand that in the current health insurance market, gap costs can be confusing and often frustrating.  One of our points of difference is that we’re completely transparent about the costs of the procedures that we offer. Unlike many other clinics, the total-out-of-pocket costs listed on our website under each procedure are inclusive of our specialist Plastic Surgeon Dr Moncrieff, hospital stay, anaesthetist, garment and post-operative visits. This makes it easy to make an informed choice before you invest your time and money into a consultation.

To find out more about the cost for surgical procedures, you can click on any of the following links:

We have payment options available

There are number of different options that you have when it comes to paying for your surgery. You may choose to fund your surgery using finance such as a loan or a low-interest credit card, or you may even be able to access your superannuation. We also offer interest-free payment plans to give you the option of payment in weekly instalments leading up to your surgery. You can find more information on the payment options page.

Book a consultation

To book a consultation just call 4920 7700 and speak to one of our friendly team members. For more information on your specific surgery and associated costs, please visit our Procedures page.

Practice Manager Jessica Laing

Blog Author:

Jessica Laing, Practice Manager, Hunter Plastic Surgery

About Jessica

Jessica joined our team in 2010 and has worked very closely with Dr Moncrieff as Patient Manager and then Practice Manager since 2015. 

Her commitment and care for patients is legendary. She has even won awards for her focus on service including at the 2020 Stevie Global Sales and Customer Service Awards as Young Customer Service Professional of the Year, as the Australasian Practice Manager of the Year at the 2019 MyFaceMyBody Global Awards and at the 2017 Lake Macquarie Business Excellence Awards.

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