How do I claim for specialists' bills (no Access Gap)?

Specialists who don’t treat you under the Access Gap Cover scheme send their bills to you. This enables you to claim whatever you’re entitled to (from Medicare and us) before paying your specialist in full.

There are 4 steps:

  1. Medicare claim: You complete a two-way claim form and submit that, and your specialist bill(s) to Medicare. You receive your Medicare entitlement.

  2. Nurses & Midwives Health claim: Medicare forwards your claim to us so we can pay the benefit towards your specialist bill.

  3. Benefit payment: We transfer the funds directly into your bank account. (From 1 January 2024 all benefit payments will be via bank transfer; cheques will no longer be an option).

  4. Specialist payment: You pay the specialist in full.