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Some practitioners provide services to BUPA patients in non-contracted hospitals. You will then notice that the amounts you are paid will be less than the regular BUPA rates. This is because BUPA pays 100% of the MBS schedule fee for services provided in Second Tier and/or BUPA Non-Agreement Hospitals or Day Hospitals.

More information can be found at BUPA’s website. Just go to https://www.bupa.com.au/for-providers, then scroll down to the “Medical providers” section and download the “Medical Gap Scheme Terms and Conditions ” PDF (or click this direct link: Medical Gap Scheme Terms and Conditions). It is on page two of that document, under the section “Services where Medical Gap Scheme benefits are
limited to 100% of the MBS fee.”

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