Estimate Example - Known Gap (Scheme)

Scenario: The Practitioner/Practice opts into a scheme with the Health Fund, but charges their own fee rate. Therefore, instead of paying up to the Medicare Benefit Schedule, the Health Fund will pay up to their own published rate.

The calculations are based on the following:

• Doctor's fee will be displayed under Fee.
• Medicare Rebate of (75%) under Medicare.
• Health Fund Rate – (is the difference between Health Fund Published Rate and Medicare Benefit).
• Gap Difference under Gap Column.
  
  
  

  Therefore if a practitioner charges above the Schedule Fee for Item 32090 please find example listed below:

  Practitioner Charges	$450.00
  Less Rebate Medicare Rebate ($221.55) Health Fund ($157.20)	$378.90
  Gap to pay	$71.25