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Bupa Medical Gap Scheme

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Why is Bupa’s Medical Gap Scheme changing?

Bupa recently introduced changes to its Medical Gap Scheme, which has caused an outcry amongst some doctors but why have they done this? Well, the answer depends on who you ask. We’ve listed the arguments for and against here to allow you to make up your own mind.

What is the Bupa Medical Gap Scheme?

The Bupa Medical Gap Scheme is Bupa’s scheme to help reduce out-of-pocket costs for its customers. These result when a customer’s chosen doctor charges more than the standard MBS fee for a hospital treatment.

If the doctor is signed up to the Bupa Medical Gap Scheme, they agree to only charge a certain fee which Bupa fully or partially pays, leaving the customer with nothing to pay or at worst, no more than $500 per specialist.

How is it changing?

Bupa has contracts with around 96% of all private hospital services in Australia. The new change means that they will no longer be offering their Medical Gap Scheme to the other 4% of hospital services which do not have contracts with Bupa.

As a result, doctors must advise Bupa customers if they are going to a contracted hospital or not and what their medical costs will be for the service. The patient can then make a decision whether to go to the hospital and face out of pocket costs or request another hospital contracted to Bupa.

What will this mean?

According to Bupa, the changes will mean greater transparency, as their customers will be fully aware of what their hospital treatment will cost them and can make an informed decision as a result. It will also mean doctors who are charging above the standard fee or who have vested interests in particular private hospital services will be made to declare those interests.

According to some doctors, the changes will mean a step closer to a US-style managed care health system, where treatment must be pre-approved by health funds. They see Bupa’s move, not as a move towards transparency, but as an attempt to determine where patients receive their care.

What has been the outcome?

As a result of the outcry, Bupa has since modified its changes, saying that customers using the public hospital system would continue to qualify for the Medical Gap Scheme, as long as it is for pre-booked elective surgery.

Meanwhile, the federal health minister Greg Hunt has ordered the ombudsman to investigate Bupa over its policy changes and social media continues to be rife with confusion and scaremongering.

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