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).

Here’s how:

  1. Claim with Medicare using any of these options:
  • Option 1: complete and submit a two-way claim form, along with your specialist bill(s), to Medicare. You will receive your Medicare entitlement.
  • Option 2: claim in person at a Medicare service centre, online using MyGov (if you’ve linked your Medicare services) or via the Medicare app. If you don’t use the two-way claim form, you’ll have to send us a Medicare Statement of Benefits so we can process your claim. How to get a copy.
  1. Teachers Health claim: Medicare forwards your claim to us (if you used the two-way claim form) so we can pay the benefit towards your specialist bill.

  2. Benefit payment: We transfer the funds directly into your bank account.

  3. Specialist payment: You pay the specialist in full (if you haven’t already).