There will be upcoming changes to our agreement with the GastroMedicine & Endoscopy Hospital Group (GME).
From 12 January 2024, the following GME hospitals in Victoria will no longer be part of our participating hospital network:
- Mornington Endoscopy, 350 Main Street, Mornington Vic 3931
- Rosebud Endoscopy, 20 Boneo Road, Rosebud Vic 3939
WHAT THIS MEANS FOR YOU
Our top priority is to reduce the impact of these changes and continue supporting you with access to high-quality care without unexpected costs.
If any of the following scenarios apply to you, we’ll cover your hospital treatment (other than any excess that applies to your cover and other small permitted gaps), provided your HCF hospital policy covers the treatment being provided and you've served the relevant waiting periods.
- You have a hospital admission with GME between now and 12 January 2024.
- You’ve booked a hospital admission with GME before 12 January 2024 and it occurs on or before 13 May 2024.
After these dates, you can still attend GME hospitals, but you might pay out-of-pocket costs as determined by GME.
We can help you find another HCF participating hospital to access reduced gap or no-gap treatment. We have several other hospitals in our network available in the Frankston and Mornington Peninsula areas.
Most surgeons and medical specialists operate across several hospitals and will work with you to make sure your surgery takes place as planned. They may also help you find an alternative HCF participating hospital in your area.
You can search for specialists in your area and check your out-of-pocket costs.
Our Cost Indicator tool can also give you an idea of the typical costs for digestive surgery, including gastroscopy procedures.
WHY THIS CHANGE IS HAPPENING
We negotiate agreements with hospitals around Australia to help members access reduced gap or no-gap treatment for hospital services included in their cover.
Our guiding principle is putting health before profit. We remain focused on building long-term agreements to deliver meaningful benefits for our members. However, we haven't been able to negotiate an agreement with GME that’s in the best interests of our members.
We’ll keep you informed of any changes to our agreement with GME via email and our website.
ABOUT HOSPITAL CHARGES AND GAPS
The gap (out-of-pocket costs)
Hospitals and the doctors who treat you bill separately for their services.
If your health cover doesn’t cover the full cost of your treatment, you’ll have to pay the difference. This is known as the gap.
Hospitals bill for accommodation, operating theatres and other hospital-related services.
If you have a GME hospital admission after the specified dates, you can still attend GME hospitals, but you might pay out-of-pocket costs as determined by GME.
Make sure you understand and are aware of any costs related to your hospital stay, so you can provide Informed Financial Consent before being admitted.
The changes to our agreement with GME doesn’t affect the arrangements we have in place with surgeons or specialists who operate at GME facilities.
Medical services (such as doctors’, anaesthetists’ or surgeons’ services) are billed separately. These costs are shared between Medicare and your health fund.
Medicare contributes a set amount for each treatment or procedure, as set out in the Australian Government’s Medicare Benefits Schedule (MBS). For in-hospital treatment, Medicare pays 75% of the MBS fee and your insurer pays the remaining 25% (provided you’re covered for the service).
Many doctors choose to charge more than the MBS fee, so there may be a gap. You may be able to avoid paying the gap by going through an HCF no-gap or known-gap (capped at $500) arrangement with a doctor who is registered under one of these arrangements.