Removal of No-Gap contract with Sonic Healthcare for in-hospital pathology services
Release date: 24th December 2009
MBF has endeavored to negotiate an ongoing provider contract with Sonic that is in the best interests of our members for more than five months. Unfortunately, we could not agree on an affordable pricing contract given Sonic requested an increase in excess of 30% of current contracted rates.
As a result, MBF's No-Gap contract and direct billing arrangement with Sonic for in-hospital pathology services have recently concluded.
MBF is disappointed that we were unable to negotiate a new contract with Sonic - this was never our preferred outcome. However, despite being disappointed with the potential impact of this on members utilising pathology services, we cannot agree to excessive price increases that simply apply pressure to premiums.
MBF must negotiate reasonable contracts with all providers to ensure private health insurance remains affordable. We will continue to make every effort to minimise the impact of this change on members, and we remain hopeful a fair pricing agreement can be negotiated with Sonic.
When does this new arrangement take effect?
The new arrangement between Sonic and Bupa took effect on 1 November 2009.
How do I know which pathology provider a hospital uses before being admitted?
Members should speak to the hospital admission staff prior to their in-patient admission to determine which pathology providers operate at the hospital. More than one pathology provider operates at many hospitals.
Which pathology practices provide gap free in-hospital pathology services for MBF members?
MBF has No-Gap arrangements in place with a number of pathology providers.
CLICK HERE TO VIEW - The list of No gap pathology providers for MBF members.
What happens if members use pathology services provided by Sonic?
Unfortunately, it is likely that some members may experience out-of-pocket charges for pathology services that are provided by Sonic during a hospital stay.
At most hospitals, however, members may be directed by their treating doctor to alternative No-Gap pathology providers. MBF has made every effort to work with Sonic to minimise the impact of this change on our members.
What is informed financial consent?
Members who now have a gap to pay for services provided by a Sonic practice need to receive full informed financial consent for all services provided during a hospital admission.
If they have not received this informed financial consent they should, in the first instance, contact the hospital admission staff regarding this matter.
What has MBF done to manage the impact of this change on our members?
MBF has approached to key hospitals advising of the changed arrangements with Sonic. We anticipate that our Network Hospitals will also endeavour to minimise out-of-hospital medical expenses for our mutual members.
MBF has provided these hospitals with lists of No Gap pathology providers for members. Our members need to receive full informed financial consent for all services provided during a stay at one of our Network hospitals. We have written to Sonic seeking assurance that our members will receive informed financial consent prior to receiving any Sonic Healthcare in-hospital pathology services.
Bupa has also made the Private Health Insurance Ombudsman aware of this development with Sonic.
