Access Gap Cover for Latrobe Health Services members 

Reduce or avoid medical gaps for your hospital treatment. Access Gap Cover helps lower out of pocket costs when you’re treated as a private patient in hospital. 

Access Gap Cover is 

  • A billing arrangement used by participating doctors to limit or remove medical gaps for in-hospital services 
  • Available to Latrobe Health Services members with eligible hospital cover 
  • Doctors choose to use Access Gap on a case by case basis 

Key benefits for you 

  • No gap or Known gap. Under a no gap arrangement your doctor bills at the Access Gap fee. You pay nothing for their in hospital medical services. Under a known gap arrangement, if your doctor charges a patient copayment, it’s capped at $500 per doctor per hospital episode. For obstetrics, the cap is $800. You receive a written estimate before treatment. 
  • Less admin. Doctors bill the fund directly. You don’t need to lodge the medical claim yourself. 

Latrobe Health Services Tip!

Remember that the 'known gap' arrangement is per doctor, per hospital episode. This means that your anaesthetist, surgeon and assistant surgeon could all charge up to $500. Check with each doctor involved in your hospital episode. 

Who can use it 

  • Members with eligible Latrobe Health Services hospital cover 
  • Services provided while admitted to hospital, hospital in the home, or hospital substitute treatment 
  • Out-of-hospital medical services are not covered under Access Gap 

How to use Access Gap Cover 

  1. Check your cover. Confirm the procedure is covered on your policy and any waiting periods are served, by calling us on 1300 362 144. 
  2. Ask every doctor. Ask your surgeon, assistant surgeon and anaesthetist if they will use Access Gap for you. Doctors decide per patient and per episode. 
  3. Get informed financial consent. If there’s a gap, the doctor must give you a written estimate before treatment. 
  4. Confirm hospital and other costs. Access Gap is for doctors’ in-hospital fees. You may still have hospital fees, prostheses costs or your excess. Check these upfront. 
  5. Pay only the copayment. If a known gap applies, pay the copayment to the doctor. The doctor bills Latrobe Health Services for the rest. Do not pay the full account yourself if Access Gap is being used. 

Find doctors who use Access Gap 

  • Use the AHSA doctor search to view doctors registered to use Access Gap 
  • Then ask if they will use it for your treatment 
  • Listing does not guarantee use 

Important details 

  • Caps. Maximum patient copayment is $500 per doctor per episode, or $800 for obstetrics. If a surgeon submits one claim including assistant fees, the combined copayment cap for that claim is $500. 
  • No hidden fees. Under Access Gap, doctors cannot charge non-clinical fees like booking, technology or admin fees. 
  • Radiology and pathology. Latrobe Health Services participates in AHSA no gap arrangements for radiology and pathology. Providers are managed through AHSA. 
  • When Access Gap won’t apply 
    - If the doctor chooses not to use Access Gap 
    - If the service is out of hospital 
    - If the doctor charges above the cap 
    - If your policy excludes the service or waiting periods are not served 

Access Gap FAQs

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When did Latrobe start Access Gap Cover?

Access Gap Cover applies to services from 1 October 2025. 

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Does Access Gap cover all costs?

No. It covers eligible doctors’ inhospital services. You may still have hospital costs, device costs or an excess under your policy. 

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What if my doctor won’t use Access Gap?

You can seek another specialist or proceed without Access Gap and pay the difference between the doctor’s fee and Medicare plus fund benefits. Ask for a written estimate either way. 

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Will I always pay nothing?

Often there’s no gap. If a known gap applies, it’s capped and disclosed upfront in writing. 

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Do I need to claim with Medicare?

Under Access Gap, the doctor submits the claim to the fund. You only pay any agreed copayment. If a provider does not offer Access Gap it will be at the practice’s discretion of how they bill. You may still have to submit to Medicare.   

Tips to minimise costs 

  • Ask each doctor if they’ll use Access Gap for your episode 
  • Request written Informed Financial Consent for any gap before admission 
  • Check hospital agreements and your excess with us before you book