Medical Gap: how to claim on medical inpatient accounts
Latrobe pays an additional benefit above the Medicare schedule fee for the following claiming options:
Provider bills Latrobe Health Services direct
If your doctor is going to bill Latrobe directly then you will only be responsible to pay any out of pocket charges the doctor may apply. However, for your doctor to bill Latrobe directly they are to have advised you of any out of pocket charges up front.
Electronic two-way accounts
If you are claiming for medical services provided whilst you were in hospital, you will need to complete a Latrobe Member Claim Form and both the Medicare Claim Form (MS014) and Two-way Claim Form (MS001).
Please note: All 3 Forms must be completed.
We will forward your accounts and Medicare claim forms to Medicare on your behalf.
If you have already submitted your medical claims to Medicare you’ll only need to complete a Latrobe Claim Form and forward this with your Medicare Statement of Benefits.
If Medicare is unable to submit your claim back to us, they will send you a benefit statement, which you will need to forward to Latrobe. To prevent delays in processing your claim, please ensure all your information is entered correctly on the claim forms.
Direct to Medicare
If your accounts are lodged directly to Medicare in the first instance, no additional benefits can be paid without a completed Latrobe claim form. We will assess your claim for the gap payment up to the schedule fee and send you a letter to confirm the Informed Financial Consent and other relevant questions required to be completed. Once returned we will adjust the account accordingly.
Any follow up or prior appointments will not be covered by your health insurance. Your hospital cover only covers your medical accounts whilst you are an inpatient in hospital.