Estimate Example - Gap (Standard)

Scenario: The practitioner or practice does not have an agreement with a health fund and has not opted into a scheme; they charge their own fees. Therefore there will be an out-of-pocket expense for the patient, which will be displayed in the Gap column of the New Estimate of Fees window.

The calculations are based on the following:

  • The doctor's fees are displayed under Fee.
  • The Medicare rebate of (75%) is displayed under Medicare.
  • Health fund (25% of MBS Fee) is displayed under Health Fund.
  • Gap difference is displayed under the Gap.


    This table shows an example of a practitioner charging above the schedule fee for item 32090.

    Practitioner Charges for Item 32090 $603.00
    Less Rebate

    Medicare ($376.90)

    Health Fund ($125.60)

    502.50
    Gap to pay $100.50