Healthcare Providers Info
Healthcare Providers hotline - 1800 226 586
Medical Practitioners
Medical gap schemes
The Doctors' Health Fund uses two medical gap schemes. Our 'Top Cover' hospital product includes our premium gap scheme, while 'Prime Choice' and 'Smart Starter' both include the Access Gap Cover scheme.
No need to ‘contract’ under our premium medical gap scheme
The Doctors’ Health Fund does not require medical practitioners to contract or register with the Fund to provide services under our premium medical gap scheme. Our scheme is different. We pay greater benefits which are based on a calculation which is applied to the doctors bill. To determine if your patient will have out-of-pocket expenses please call the Healthcare Providers hotline 1800 226 586 with the item numbers and fees which will be charged.
What to do when your patient has hospital cover with our premium medical gap cover?
To claim these benefits the patient’s aggregated bills need to be submitted to The Doctors’ Health Fund directly or to the patient. The claim needs to be accompanied by a completed Informed Financial Consent form.
Extras providers
The Doctors’ Health Fund does not require ancillary service providers to register or contract with the Fund for their patients to claim benefits for their services. We do however encourage our members to seek the convenience of providers who use HICAPS to provide them with on the spot claiming.
The Fund’s rules define the services of the following ancillary service providers as eligible for benefit payments where a member has cover for their services –
| General dental services |
registered dentist or specialist dentist |
| Major dental services |
registered or recognised orthodontist, endodontist, periodontist, oral surgeon, prosthodontist, pedodontist or other recognised specialist |
| Optical |
registered ophthalmologist, registered optometrist or a prescription filled by a registered dispenser |
| Therapies |
registered practitioners of orthoptics, occupational therapy, speech therapy, dietetics, podiatry, physiotherapy, and psychology. |
| Home nursing |
registered nurse |
Hospitals
The Doctors’ Health Fund is a member of the Australian Health Service Alliance who manage hospital contracts on our behalf. The Fund now participates in the Alliance’s Access Gap Cover scheme for our 'Prime Choice' and 'Smart Starter' hospital products. The Fund operates its own registered gap cover scheme – AMA Gap cover – which is included in our 'Top Cover' hospital product.
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