As specialist fees attract increasing government scrutiny, Medibank has partnered with HealthShare to provide GPs with a year’s access to specialists’ out-of-pocket fees.
HealthShare’s collaboration with Medibank will give its members and their GPs visibility into specialists’ out-of-pocket costs from the previous 12 months. But experts say more structural reform is still needed.
The news comes as the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026, which would allow the government to publish individual specialists’ fees for common and out-of-pocket services, passed the senate last night.
The information will be accessible via HealthShare’s specialist referrals directory, which the digital health platform said is used by more than 26,000 GPs each month.
Users will be able to identify specialists participating in Medibank’s GapCover and the No Gap program.
Eligible Medibank members can already access no gap cover for a range of elective procedures – including cataracts, medically necessary plastic and reconstructive procedures, general surgery, ACL reconstruction, endoscopy, and joint replacement – when treated by a participating surgeon at a participating hospital.
Currently, East Sydney Private is the only hospital performing plastic and reconstructive procedures and cataract surgery under the No Gap program. It’s also the only hospital offering all programs.
Approximately 700 surgeons and anaesthetists in 40 unique hospitals across Australia participate in at least one of Medibank’s No Gap Programs. However, more than two-thirds of listed hospitals offer only one program.
Co-founder of HealthShare, Rami Weiss, said choosing specialist care was an important decision, and that making Medibank’s GapCover arrangements more accessible would help GPs have better-informed conversations and support their patients’ individual needs and circumstances.
Nathan Crothers, senior executive of Medibank Member Health Programs, said increasing access to information for customers and their GPs about specialists involved in the GapCover arrangements could help prevent delays in seeking care.
“We want to make it easier for our customers to understand and navigate their healthcare options,” he said.
According to the Australian Institute of Health and Welfare, almost two million Australians delayed or skipped specialist care, and almost one million cited cost.
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Associate Professor Vikram Palit, founder and chief executive of the digital referral platform Consultmed, described the program as a “great initiative”, particularly for GPs referring patients.
“If that leads to more independent specialists and private health insurers going down that track, and means more people advertise their fees on cost finders, ultimately that’s better for the patient,” he said.
Professor Palit told The Medical Republic it aligned with broader efforts to rein in specialist care costs, including the Department of Health, Disability and Ageing’s consultation on specialist affordability and access.
However, he said the government should also seriously consider alternative models of care, such as advice-and-guidance services that give GPs access to specialist opinion without a formal referral, which he argued would prevent unnecessary visits, and, more broadly, virtual models of care.
“We can get really stuck in this discussion about making specialist fees transparent and about carrot-and-stick approaches to controlling them, but I think there’s actually a much larger opportunity in looking at other models of care that improve access to specialist opinion without always requiring a referral,” he said.
