PET - Plain English Taxonomy

Attribute:	OI13202
Concept:	Regulatory Disclosures Medical Services Gap Count
Label:	Number of gap services
Concept Guidance:	This is the number, during the relevant period, of medical services provided where a gap payment is applicable. A gap payment is where the fee charged by the medical practitioner exceeds the amount of benefits paid by the insurer.

Dimensions

Dimension	Member	Description
GapAgreementDimension	(KnownGapAgreement)	This dimension categorises the reported data according to whether there is an agreement between a medical practitioner and an insurer, in relation to the benefit paid by the insurer relative to the fee charged by the medical practitioner. The information reported is in relation to an agreement where the difference between the amount of benefit paid by the insurer and the fee changed by the medical practitioner is a known amount, which is the out of pocket expenses to be paid by the insured person.
SpecialityGroupingsDimension	(Pathology)	This dimension categorises the reported data according to the speciality groupings as described in the Medicare Benefits Schedule book. The information reported is in relation to pathology services.

Dimension

Member

Description

GapAgreementDimension

(KnownGapAgreement)

This dimension categorises the reported data according to whether there is an agreement between a medical practitioner and an insurer, in relation to the benefit paid by the insurer relative to the fee charged by the medical practitioner.
The information reported is in relation to an agreement where the difference between the amount of benefit paid by the insurer and the fee changed by the medical practitioner is a known amount, which is the out of pocket expenses to be paid by the insured person.

SpecialityGroupingsDimension

(Pathology)

This dimension categorises the reported data according to the speciality groupings as described in the Medicare Benefits Schedule book.
The information reported is in relation to pathology services.