Access Gap Cover is now available to Latrobe Health Services members with eligible hospital cover.

It reduces or removes out-of-pocket medical costs when you are treated as a private patient in hospital.

What is it?

  • Doctors use it to bill at agreed rates
  • You may pay no gap or a capped known gap
  • Doctors decide case by case

How it helps

No gap. Your doctor bills at the Access Gap fee. You pay nothing for their in‑hospital medical services.

Known gap. If a co‑payment applies, 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 us directly. You don’t lodge the medical claim yourself.

Who can use it

  • Members with eligible Latrobe Health hospital cover
  • Services provided while admitted to hospital, Hospital in the Home (HITH), or hospital substitute treatment
  • Out‑of‑hospital medical services are not covered under Access Gap

Contact us to check if you’re covered

How to get started

  1. Confirm your cover
    Make sure the procedure is included and any waiting periods are served.
  2. Ask every doctor
    Ask your surgeon, assistant surgeon and anaesthetist if they will use Access Gap for you.
  3. Get Informed Financial Consent
    If a gap applies, your doctor provides a written estimate before treatment.
  4. Check other costs
    Access Gap is for doctors’ in‑hospital fees. You may still have hospital fees, device costs or an excess. Confirm these upfront.
  5. Pay only the co‑payment
    If a known gap applies, pay the co‑payment to the doctor. The doctor bills us for the rest.

Important details

  • Caps.
    Maximum patient co‑payment is $500 per doctor per episode, or $800 for obstetrics. If a surgeon submits one claim including assistant fees, the combined 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 participates in AHSA No Gap arrangements for radiology and pathology.

Tip: Ask for the written estimate before admission and confirm any hospital excess on your policy.

Planning a procedure

  • Check your cover
  • Find an Access Gap doctor
  • Get your written estimate
  • Confirm hospital and device costs
  • Book with confidence

Check your cover