Simplified
Billing
The Simplified Billing process is another way that
the Society aims to eliminate or further reduce your
out of pocket expenses. It also simplifies the number
of forms to be completed, and invoices and cheques
to be forwarded on.
Doctors who are willing to participate in the Society’s
Simplified Billing process will be paid an additional
20% above the Commonwealth Medical Benefits Schedule
for the services provided to the member.
In this case, the doctor will forward their accounts
for your treatment directly to us. Druids Friendly
Society will then claim the Medicare rebate on your
behalf. When the Medicare refund has been received
by us, we will add our benefit to the refund, and
forward payment directly to the practitioner.
Gap Cover
Druids Gap cover is an additional benefit that will
eliminate or reduce the medical gap for hospital in-patient
medical services and provide further value to private
health cover for members.
It is important for members to discuss the fees with
their doctor prior to commencing treatment. Your doctor
is required to provide an estimate of any out of pocket
medical expenses that you may incur.
NO GAP
If your doctor of choice uses the Simplified Billing
process and accepts Druids agreed benefit as payment
in full of the fee, there will be no further payment
required when your medical treatment in hospital is
completed.
KNOWN GAP
If your doctor of choice agrees to use the Simplified
Billing process but charges above Druids agreed benefit,
there may be an out of pocket expense that you will
be required to pay. The doctor will be able to advise
you of the amount that you may be charged, outside
of the cover provided.
Emergency Treatment
In cases of emergency treatment it may not be possible
to discuss fees with your doctor prior to treatment.
We will still pay the Gap Cover benefit provided that
the doctor confirms to you or your representative
that they will participate in the Simplified Billing
System and advises you of any anticipated out of pocket
expenses (Known Gap).
The Society wishes to clearly explain that it is not
our intention to intrude on the doctor/patient relationship,
nor do we wish to interfere with the fees being charged
by doctors.
However, Gap Cover Benefits depend on you receiving
Informed Financial Consent (knowing how much you will
have to pay) and the doctor agreeing to participate
in the Simplified Billing System.
The Gap Cover system applies to all medical practitioners
involved in your hospital treatment including Anaesthetics
but excludes Radiology, Pathology and Optometrist’s
services |
