Australia's largest private health insurer, Medibank Private, is rapidly moving towards providing its members with lists of doctors performing in-hospital and day surgery procedures under no gap arrangements.
The announcement of the move follows criticism from the private health insurance Ombudsman, Norman Branson, who yesterday criticised the lack of information available to consumers about doctors who offer no gap services.
The medical gap we are referring to is the difference between the fee patients are charged by their specialists and the total benefits they receive from Medicare and their private health insurance fund.
Currently Medibank Private - like most private health insurers - offers a service where its members can ring and ask if specific doctors performing in-hospital and day surgery procedures charge under no gap arrangements.
However, members are not furnished with a full list no gap doctors.
Says Medibank Private managing director, Mark Burrowes: "We recognise that this arrangement is less than satisfactory and we're now working towards better meeting our members' expectations.
"However, it is crucial that before doing anything, we consult fully with doctors. Their approval is critical to the success in reducing and eliminating out of pocket expenses."
Mr Burrowes is confident of doctors' support.
Since the introduction of Medibank Private's initial "GapCover" scheme in November 1999 - which was followed by a further enhanced scheme late last year - there has been a huge uptake in the number of doctors using these schemes.
Currently this figure is at over 4,200 doctors nationally. (See graph below)
Mr Burrowes believes this is "a wonderful result" given that the fund's gap schemes have only been in place for little over a year, also keeping in mind that the doctors being referred to are strictly those who perform in-hospital and day surgery procedures.
"Another major coup for us is that the number of in-patient medical services which did not incur out of pocket expenses, rose to 72 per cent as at the end of March this year.
"We're hopeful of this figure reaching the 80 per cent mark by the end of the year."
Mr Burrowes says while the figure is encouraging, Medibank Private will continue promoting its gap cover schemes to doctors around Australia with the aim of building an ever-expanding network of doctors.
"The greater the number of doctors who participate, the greater the choice and the more widespread the benefits are to members."
Reducing and eliminating out of pocket expenses does come at a cost.
Says Mr Burrowes: "We will be investing between $35-$40 million annually to this end."
