Ezyclaim
Gap payments
What is the gap?
The Federal Government sets a dollar amount – known as the schedule fee – for every in-hospital medical treatment. When you’re treated in hospital, Medicare pays 75% of the schedule fee and your HBA private hospital cover the remaining 25%.
However, some doctors and specialists charge more than the schedule fee and the difference between the two is the gap and is paid by you out of your own pocket.
The HBA Ezyclaim system
Our Ezyclaim system makes it possible for you to receive in-hospital care from specialists and in most cases, never see a bill, or pay a gap.
Your specialist agrees with HBA on a capped, known gap that will be charged for services and also agrees to bill us directly. There is nothing for you to do and in most cases, there is nothing for you to pay. With Ezyclaim, most members’ in-hospital medical claims are now gap free.
Can I still incur 'out-of-pocket' expenses when I go to hospital?
Sometimes there can be a difference between what we pay on your behalf and the total cost of your hospital treatment.
When this happens, you may have to pay something towards the cost of your treatment out of your own pocket. When you are treated in hospital, there are two types of charges:
- Hospital costs
and - Medical costs.
Hospital costs
Hospital costs include things like accommodation and theatre fees. Some hospital products have an excess and/or co-payment.
If you have one of these hospital products, if you do need hospital treatment, you will need to pay the agreed excess and/or co-payment.
If you choose to be treated at a Participating Private Hospital, you will be fully covered for accommodation and theatre fees, less any excess you have agreed to pay.
If you choose to be treated at a non-participating hospital, you may incur out-of-pocket expenses for these services.
Medical Costs
Medical costs are charged by the doctors and specialists who were involved with your treatment. These can include Anaesthetists, Cardiac surgeons, Orthopaedic surgeons, Obstetricians and Radiologists.
Sometimes there can be a difference between what we pay on your behalf for medical costs and what the total bill is. In these cases, you may have to pay something towards the cost of your doctors' bills.
Thanks to our Ezyclaim direct billing system, you can avoid out-of-pocket expenses in relation to your medical expenses.
What is Ezyclaim?
Ezyclaim is a direct billing system which is designed to help our members avoid any out-of-pocket expenses when treated in hospital.
If your specialist uses Ezyclaim, your specialist simply bills us directly. In most cases, you don't receive a bill or pay any out-or-pocket expenses.
How can Ezyclaim help me avoid 'out-of-pocket' expenses?
Ezyclaim offers peace of mind, security and convenience. If your specialist uses Ezyclaim you will either have:
- Nothing to pay
or - You will know exactly how much you will have to pay prior to your treatment.
How do I use Ezyclaim?
All specialists can choose to use Ezyclaim. Simply ask your doctor about Ezyclaim.
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