Adding confusion to recent change

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The AMA appears to be adding confusion to recent changes announced by Bupa to its Medical Gap Scheme.

Under the change, doctors will be required to inform a patient if they will not be treated in a Bupa contracted hospital and what out-of-pocket medical costs they will face. Currently, more than 95 percent of the total volume of private hospital services delivered to the fund's members are covered by contracts with Bupa. 

The fund's Medical Gap Scheme, which caps out-of-pocket costs per specialist treatment at a maximum $500, will not apply to the around 4 percent of private hospital beds not currently covered by contracts with Bupa. 

According to AMA president Dr Michael Gannon, "...Bupa's now added this additional layer of difficulty to patients, expecting patients, expecting GPs to have the literacy to know whether or not a hospital their doctor might choose to look after them in is in contract or out of contract with Bupa. And, if they're not in contract, Bupa's going to retreat all the way back to the scheduled fee, potentially leaving people hundreds of dollars, if not thousands of dollars, out of pocket."

Bupa publishes a list of specialists that participate in its Medical Gap Scheme. It is available online.

Dr Gannon also claimed Bupa members could face new out-of-pocket costs even in circumstances where specialists were willing to treat on a 'no-gap' basis.

The country's largest private health insurer has previously said the change is simply designed to make the system more transparent, ensuring people are aware up-front of any out-of-pocket costs before deciding where they receive treatment. It will still make a contribution, and in many cases it will be exactly the same as what happens now, in that patients will face out-of-pocket costs.

" means doctors will have to be transparent about how much extra they’re charging patients as a result of their private cover," said Bupa in a recent statement.

"At the end of the day, some doctors are reacting to our changes because it means the out-of-pocket costs they choose to charge their customers will become very obvious.

"Some doctors have also chosen to put out false or incorrect statements about these changes to deflect attention from the real issue; transparency," it added.