Visits to a Specialist

Does private health insurance cover visits to a non-GP specialist? 

No. Private health insurance does not cover visits to see a non-GP specialist in their consulting rooms.

Instead, visits to a non-GP specialist in their consulting rooms are covered by Medicare.

If you are enrolled with Medicare, it will pay some or all of the cost:

• If your specialist bulk bills, Medicare covers 100% of the cost and you do not have to pay.
• If your specialist does not bulk bill, Medicare pays 85% of the scheduled fee and you have to pay the 15% plus any additional amount your specialist charges.

However, if you have Hospital Cover and the appropriate Hospital Cover tier (Basic, Bronze, Silver or Gold), private health insurance may cover some or all of your costs of treatment or surgery by the non-GP specialist in a public hospital or a private hospital.