You might have heard of the Medicare Benefit Schedule (MBS). This is a list of the medical
procedures Medicare covers, as well as what they’ll pay towards treatment.
When you are admitted to hospital as a private patient, your specialist’s bills will be covered
up to the MBS fee. Medicare will cover 75% of the MBS fee, while we will cover the remaining
25%. An out-of-pocket expense occurs when there is a difference between your specialist’s fees
and the combined benefit provided from Medicare and HBF.
To help eliminate or reduce these out-of-pocket expenses for you, HBF participates in the Australian Health Service Alliance (AHSA) Access Gap Cover (AGC) arrangement for all states outside of Western Australia.
If your specialist participates in the AGC arrangement, they have the option to opt-in or opt-out of the arrangement on a case by case basis. When your specialist chooses to opt-in to AGC they have the option of billing one of two ways: