澳洲利用GAP COVER来减少你的OUT OF POCKET

在澳大利亚医疗保健



看到了不少帖子关于买了私人医疗保险反而需要多付钱的疑问，希望以下解答可以满足大家：

1.如果只有MEDICARE,你只能在WAITING LIST上排队上公立医院，不能选择自己的医生和上私立医院；
2.选择了住院保险，根据不同级别的COVER，可以选择医生和医院（公立或者私立医院）；
3.一般住院涉及以下费用：住宿费，手术室费用，医生收费。一般来说，如果你在你COVER允许的情况下，以及过了等待期，你去MEDIBANK的MEMBER'S CHOICE HOSPITAL,你的住宿费用和手术室费用是由保险公司出的，你也可以要求医院给你提供私人病房；医生收费方面，每一个手术会有一个ITEM NUMBER, 每一个ITEM NUMBER会有一个政府规定收费(MEDICARE BENEFIT SCHEDULE,简称MBS，可以在WWW.HEALTH.GOV.AU/MBSONLINE查到每一个ITEM NUMBER的政府规定收费）。可以很肯定告诉大家，基本上没有医生完全按照政府规定收费来收取费用，也就是为什么大家都奇怪买了保险反而会需要付钱。
4.GAP COVER是一项限制医生收费过高的SCHEME，每个有私人住院保险的会员都可以和医生商量能否参加GAP COVER，如果医生参加GAP COVER，那医生的收费就不能超过政府规定收费$800元.这主要是针对大型手术，像前面提到OUT OF POCKET 几千块的情况就不会出现。
5.是否参加GAP COVER完全取决于医生，同时也是CASE BY CASE，医生可以这次参加GAP COVER，下次不参加（没人能管得了医生怎么收费）

希望帖子能帮到大家！

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我知道现在悉尼的一些公立医院现在鼓励病人用私人保险，而且有专门人来谈，能够减免什么费用。
具体操作就不清楚了

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记得out of pocket 超过1111后，safetynet 可以报销超过部分的80%？？

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一般住院涉及以下费用：住宿费，手术室费用，医生收费。一般来说，如果你在你COVER允许的情况下，以及过了等待期，你去MEDIBANK的MEMBER'S CHOICE HOSPITAL,你的住宿费用和手术室费用是由保险公司出的，你也可以要求医院给你提供私人病房

---Does it mean if I have got Medibank private insurance (of course, after the waiting period) and go to public hospital, I can have my own private room and do not need to share with others after the operation?

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i reckon he meant private hospital for the member choice hospitals.
i dun think you can choose private room in public hospital.

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I see. Still the same then. You still need to pay about $3000 out of pocket if you want to give birth in private hospital.

If I'm healthy and do not need operation, is it necessary to go to private hospital? I have private insurance though

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Insurance is for peace of mind.
I don't want to claim the insurance or use centerlink at any time. It's just there to help reduce the risks once something terrible happens.
YOu don't have to pay that much if giving birth in provate hospital. As I said, safetynet will give 80% rebate after you pay over 1111 out of pocket money.
Even though you need to pay 3k or more, i still think it better to be in private hospital. You would get much better service if there's any complication.
I reckon good mid-wives and doctors work in private hospitals for good money.
You might end up getting young interns to deliver your baby in public hospitals.

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Under all the hospital covers at Medibank private, as long as you serve respective waiting periods, when admitting hospital (no matter public or private), you can request your private room. however, there is no "private room guarantee"

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Safety net at Medicare is the benefit for all residents who have Medicare eligibility, and it has no relationship with private health's Gap Cover Scheme.
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