We've had great help from this forum and have decided to sign up for private insurance company.
Our choices were down to Medibank, Bupa, TUH (my husband is in education) and Peoplecare and have inquired to all of them and got quotes/plan details.
One thing we are still confused and hoping to get some advice here is about the gap cover.
Apparently, Medibank has this $500 cap system.
Under this system, what we were told is that, given that the doctor/specialist is participating in gap cover, Medibank caps at $500 for out of pocket cost regardless what the doctor/specialist charges. (So the gap charge can be $30000 and you'd still only need to pay $500)
This is per procedure and per doctor/specialist, not per item number.
Other companies seem to have "access gap" system where we have been explained that the doctor/specialist (again, given that they are participating) can only charge up to $400 maximum out of pocket charge.
This is per item number.
So what we're trying to understand here is whether some cases can have multiple item numbers under 1 procedure or not.
For example, could there be 5 item numbers under 1 procedure??
Because in that case, there'll be maximum $500 that's out of pocket if with cap system, but $2500 if with access gap system, is that right?
Or is it always 1 item number per 1 procedure?
We've never had (and luckily never had to) private insurance, so all there item numbers and gap cover etc are new to us (and finding them quite confusing!), but we're hoping once we signed up with one company, we'll stay with them and not have to shop around again (at least for a while), so we want to make sure we don't misunderstand the information.
Given that anything can happen anytime, this "cap" system with Medibank sounds really good, but we weren't sure if this was right....
A) if 1 procedure has 1 item number and is performed by 1 doctor, and it costs $10000 above the government scheduled fee, we need to pay $500 out of pocket with Medibank but $400 with other companies who has "access gap".
B) if 1 procedure is performed by 2 specialists and they have 3 item numbers each (if that's possible?), and it costs $10000 above the scheduled fee, it'll be $1000 ($500 per specialist) with Medibank but $2400 with other companies with access gap.
Is above understanding correct??? (Feel like I'm back at school... and I was never good at math!!!)
If anyone who's with medibank or/and with other companies that use this "access gap" could advise, that would be great.
Sorry about a long/confusing post... thanks for all your help