Which Private Health Funds?

Historically, the vast majority of Intensivists around Australia have not charged their patients gaps.

However, many Intensivists believe that the current Medicare rebates for their services are clearly inadequate, and are well below those recommended by the Australian Medical Association (AMA) as being fair fees. The Australian and New Zealand Intensive Care Society (ANZICS) has been negotiating with the Federal Government for several years to improve the rates, but without success.

In addition, the loading offered by most health funds for Intensive Care services is only between 2 to 12% above the Schedule Fee, and varies widely between different health funds. This is significantly less than that offered to other specialists (see Patient Billing).

ANZICS and individual Intensive Care Units have tried negotiating with a number of the private health insurance funds to increase their loading, again without success.

Accordingly, some Intensive Care Specialists may choose to charge gaps if they believe that the current payment for their services is inadequate.

Private health insurance funds may offer to pay Intensivists a loading on top of the Medicare rate for services they provide.

To receive this loading, the Intensivist must agree not to charge that patient a gap - that is, it is an incentive for the specialist to not charge gaps.

The amount of this loading may vary enormously between Health Funds, and even between different Intensive Care specialists with the same Health Fund in the same State.

Examples of Health Funds who offer LARGER loadings for Intensive Care services are:

·          AHSA (WA) - 45%

·          Department of Veterans Affairs (Australia-wide) - 20%