The access gap agreement is a form of health insurance designed to help patients reduce their out-of-pocket expenses when receiving medical treatment. It is a formal agreement between private health insurance companies and healthcare providers, including hospitals, doctors, and other medical practitioners.
The idea behind the access gap agreement is to provide patients with a greater level of financial protection when undergoing medical procedures that are not fully covered by their insurance policy. When a patient receives treatment that is covered by their insurance policy, the insurer will typically pay a set fee that is based on their pre-determined fee schedule.
However, in some cases, the medical provider may charge more than the fee schedule amount. This is known as the gap payment. The access gap agreement provides patients with the option to reduce or eliminate this gap payment by allowing the medical provider to bill the health insurer directly for the difference.
As a result, patients who are covered under the access gap agreement can receive medical treatment without having to worry about being out of pocket for the gap payment. Instead, the medical provider will receive full payment from the insurer, and the patient will only be responsible for any applicable excess or co-payment fees.
It`s important to note that not all health insurance policies include access gap agreements, and it`s up to the patient to verify if their policy includes this coverage. Patients can check with their private health insurance provider to see if they offer an access gap agreement or if they have any other options available to help reduce their out-of-pocket expenses.
In conclusion, the access gap agreement is a valuable tool that can help patients reduce their financial burden when receiving medical treatment. By allowing medical providers to charge more than the fee schedule amount and then billing the insurer directly for the difference, patients can receive the care they need without worrying about being out-of-pocket for the gap payment. As a result, patients can focus on their health and well-being, rather than the financial burden of medical treatment.
