Following consultation with anaesthetists and billing agents, we understood that procedure weighting for high complexity procedures isn’t always aligned with reality.

Feedback received also detailed that high volume, low complexity procedures with already low to no out-of-pocket costs shouldn’t need further investment beyond the increased RVG unit value.

To help address these pain points, we introduced both the known gap and no gap option in our new network. This provides anaesthetists with the option to either charge no gap or a known gap up to a maximum of $500 for more complex procedures, with 5 or more RVG base units.

Importantly, it will reduce uncertainty around out-of-pocket costs and help improve the overall member experience.

Yes. Where the MBS item number has an ASA allocated unit, nib will pay $45 per unit. This $45 is applicable across all RVG categories.

No. You do not have to join the new GapSure Anaesthetics network. nib MediGap scheme is still available to anaesthetists and medical specialists which provides specialists with the option to charge a no gap fee to nib members on a case-by-case basis.

Alternatively, you can continue to charge your existing private fees if you do not wish to participate in nib MediGap or the new network.

Like all health funds, nib is required by legislation to pay 25% of the MBS on a procedure, or in addition to the 25%, an amount up to the schedule fee under MediGap when you elect to use the scheme

No. Once you’ve registered for nib’s GapSure Anaesthetics network, you cannot opt-out and the application of billing to nib members must be consistent.

Alternatively, nib’s MediGap scheme is still available to anaesthetists and medical specialists which provides specialists with the option to charge a no gap fee to nib members on a case-by-case basis.

nib partnered with Honeysuckle Health to launch its first of a kind anaesthetics network designed to provide members with greater certainty when it comes to claiming and out-of-pocket expenses. In addition, it helps to provide anaesthetists with greater flexibility when billing members, while meeting earning expectations.

The network has initially been developed for anaesthetists because they are commonly involved in surgical procedures across most disciplines. In addition, out of pocket expenses for anaesthetics has been one of the biggest pain points experienced by nib members.

In addition, Honeysuckle Health took onboard feedback from anaesthetists that the nib MediGap scheme did not best reflect their billing structure.

By providing anaesthetists with the option to choose between a no gap or known gap fee, we believe it will help to reduce common pain points for specialists when charging members for more complex procedures.

A no gap fee means nib members will not be charged any out-of-pocket costs for medical treatment. This only applies to less complex procedures.

A known gap fee means nib members can only be charged a maximum out-of-pocket expense of $500 for medical treatment. Charging a known gap fee is at the discretion of the anaesthetist, however, will only be applied for more complex procedures (5 and above base units).

The main difference between the two networks is that unlike nib’s MediGap scheme once an anaesthetist decides to ‘opt-in’ to the GapSure Anaesthetics network they cannot opt-out on a case-by-case basis.

This provides greater certainty around costs for members when going to hospital as they will know that once an anaesthetist opts into the network, they can only be offered a known gap or no gap option.

It also helps to avoid sometimes difficult conversations for members and their surgeon or anaesthetist around fees providing a better member experience.

In addition, it’s nib’s only program that provides the option for specialists to charge a known gap fee.

Yes. On behalf of nib, Honeysuckle Health has been engaging with anaesthetists, the Australian Medical Association (AMA) and billing agents to gain their important feedback regarding the new network.

We have an agreed understanding that:

• High volume, low complexity procedures with already low to no out-of-pocket (OOP) shouldn’t be over invested in or expose nib members to increased OOP.
• Procedure weighting for some high complexity procedures isn’t aligned with reality in its current state.

We have seen positive responses to:

• Meeting provider earning expectations, which includes patient OOP.
• A model that recognises the time and complexity of the procedure.

We have adapted our thinking along the way:

• Incorporating a known gap component on high complexity procedures.
• Applying consistent RVG pricing.

Anaesthetists across Australia are invited to join nib’s GapSure Anaesthetics network. There are no restrictions on joining the network, including location or care delivery. As always, your clinical autonomy will be preserved.

To find out how your personal billing profile would look under the network, or for any further questions, please contact Honeysuckle Health at [email protected] or call 1800 411 633 (Mon-Fri: 9:00 am – 5:00 pm AEST/AEDT).

You can read the terms and conditions here

Yes. A known gap fee means nib members can only be charged a maximum out-of-pocket expense of $500 for medical treatment. Charging a known gap fee is at the discretion of the anaesthetist, however, will only be applied for more complex procedures (5 or more RVG base units).