If you’ve got a hospital procedure coming up, one of the first things you’ll want to know is what it’s going to cost. The good news is that Medicare and your private health insurance covers a portion of your treatment. But if a doctor charges more than the Medicare Benefits Schedule (MBS) fee, the difference is known as the gap — and it can influence your out-of-pocket costs.
It’s also important to know that not all doctors use Access Gap Cover, and not all health funds offer it. At see-u by HBF, we do - because it’s one of the most effective ways to keep your private hospital costs predictable and fair.
What Is the Gap?
The gap is the amount a doctor charges above the MBS fee. It varies depending on the doctor, the type of procedure and their practice costs. A higher fee doesn’t mean anything is wrong - it simply means their charge is above the standard amount Medicare recognises.
Understanding the gap is one of the easiest ways to avoid surprise out-of-pocket costs.
How Access Gap Cover Helps Reduce Out-of-Pocket Costs
Access Gap Cover (AGC) is a billing arrangement that can lower — and sometimes remove — the gap you pay for private hospital treatment.
Here’s how Access Gap Cover works:
- Your doctor agrees to charge within a set limit
- see-u by HBF pays a higher benefit behind the scenes
- Your out-of-pocket costs become lower or disappear completely
Because AGC participation is optional, each doctor decides whether they’ll use AGC for your treatment. This is why checking early is so important.
A Real Story From Our Members
We talk about Access Gap Cover a lot because it genuinely makes a difference.
One see-u member recently saved nearly $40,000 in potential out-of-pocket costs after learning about AGC and asking their surgeon whether they could be treated under the scheme.
A number that big isn’t typical — but it shows how powerful a simple question can be. Even smaller savings matter when you’re juggling life, family and the realities of adulting.
Real talk: Most people don’t realise they can ask their doctor about Access Gap Cover. A two-minute conversation can completely change what you end up paying.
Why We Offer Access Gap Cover
Health costs can rise quickly, especially during hospital treatment. Access Gap Cover helps provide:
- More cost certainty
- Fewer unexpected fees
- Smoother, clearer planning before your procedure
AGC-participating doctors bill us directly, which means less paperwork and less back-and-forth for you.
How to Make the Most of Access Gap Cover
You can significantly reduce your private hospital costs just by asking the right questions early.
Here’s what to do:
- Ask early: Before confirming your procedure, check whether your doctor will treat you under Access Gap Cover.
- Request a written quote: This helps you understand any potential gap fees upfront.
- Search for AGC-friendly doctors: Use our provider search tool to find specialists who regularly participate in AGC.
Member tip: If you remember one thing from this blog, let it be this: “Do you participate in Access Gap Cover?”
This question alone can save you hundreds — sometimes thousands.
Why Access Gap Cover Matters
Private health insurance is meant to give you confidence and control.
By offering Access Gap Cover, see-u by HBF is helping make private hospital treatment simpler, clearer and more affordable.
So next time you’re preparing for a hospital visit, don’t just ask about the procedure.
Ask about the gap.
That one conversation can make your entire hospital experience easier to navigate.
Want to learn more about Access Gap Cover?
We’ve got you sorted — learn more here.
Looking for a doctor who participates in AGC?
Use our provider search to find AGC-friendly specialists near you.
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