Australia's largest and only nationally-based private health insurer, Medibank Private's 'GapCover' scheme is the first scheme of its kind to be approved under the Federal Government's new gap cover legislation.
According to Medibank Private managing director, Mark Burrowes, under the new legislation, the health insurer's scheme will provide members with greater financial certainty while at the same time strengthening the doctor-patient relationship and addressing doctor concerns about contracting with insurers.
Medibank Private's 'GapCover' was originally introduced in November last year with considerable success. The scheme has now been further enhanced to meet new legislative requirements.
Says Mr Burrowes: "The new gap cover legislation doesn't revoke existing legislation. It simply opens up a further option. It means that doctors already using the scheme can continue doing so or they can switch over to the new scheme.
He says the new scheme will continue to allow Medibank Private to reduce or eliminate medical gap payments, giving patients the opportunity of making informed choices about the services they access and the cost of those services.
'Doctors are still obliged to provide patients with informed financial consent about the anticipated cost of procedures, where possible, before they actually occur, guaranteeing no out of pocket cost or a maximum -known - gap payment of $800 per episode of care.
"For the patient, the most significant change between the new and the old 'GapCover' schemes is that doctors will have to provide patients with an estimate of costs in writing and that patient will have to acknowledge these estimates.
"Also, when referring patients to a third party for further treatment, doctors will have to declare any financial interest they may have in that third party."
Mr Burrowes says Medibank's new scheme addresses doctors' ideological concerns regarding contracts and adds more impetus to the already significant success of 'GapCover'.
"Doctors will continue to decide which patients will participate in gap cover, without the need for a written contract."
Mr Burrowes says Medibank Private has no interest in interfering in clinical decision-making or the relationship between doctor and patient.
He says Medibank Private is well aware that the Australian Medical Association may still have some concerns about the new scheme and that the health insurance fund will continue its discussions with the profession to reach common ground.