Aussies warned about ‘double dipping’ by medical specialists 

If you’ve used health insurance to pay for surgery in a private hospital or clinic, check your bill to make sure you haven’t been charged a Gap incorrectly. That’s the advice from Private Healthcare Australia, the peak body for the health insurance industry, after allegations that some specialists (including surgeons and anaesthetists) have been ‘double dipping’ fees. 

Last weekend, The Age revealed allegations by a whistleblower that a number of doctors in Victoria had incorrectly charged patients Gap fees, even though they had ‘no Gap’ agreements with the patients’ insurers.  

The newspaper said private health insurers across the country were now checking their records for overbilling. At the same time, the federal government is investigating claims that some specialists have bulk billed Medicare for their services, while also charging patients. 

Private Healthcare Australia CEO Dr Rachel David said the allegations were “deeply disturbing”. 

“When you seek the help of a surgeon and an anaesthetist you are typically at your most vulnerable. You do not expect them to be financially exploiting you at the same time,” she said. 

Have you been charged incorrectly for surgery? Here’s how to check 

1. Call or email your health insurer and ask them to examine the bill for your surgery and check whether you should have been charged out-of-pocket fees or not. If you were charged a Gap and shouldn’t have been, ask your insurer to investigate.  
   Find out how to contact your insurer here. 

2. Check your Medicare Claims History Statement to see whether you were bulk billed for the procedure. You can do this via MyGov (if your Medicare account is linked) or the Express Plus Medicare mobile app. If you were charged a fee for a procedure but your records show you were also bulk billed, report it to the government by filling out the health provider fraud tip-off form. Alternatively you can call the fraud hotline on 1800 829 403 or email reportfraudorcorruption@health.gov.au. 

What is a Gap, and what is a ‘no Gap’ agreement? 

Read The Age story here. 

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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