HICAPS shows the claim, not the cover. Here's how to check a patient's gap before they arrive.

It is Monday at your front desk. A patient is booked for Thursday. HICAPS will process their claim at the point of sale, but it will not tell you beforehand whether the cover is active or what the patient will actually pay. So before they arrive, a string of small things has to happen by hand. Someone has to notice the appointment needs checking. Find the patient's fund details, and chase them if they are missing. Call Medibank, sit through the IVR, hold, and ask the right questions in the right order. Get the answers somewhere useful. Text the patient their gap. And if anything is off, catch it now, not when they are at the counter.

Every one of those steps is manual, and every one lands on your reception team. The phone call, the part everyone fixates on, is just the link you can hear.

What the coordination actually costs

In a five-practitioner clinic, running that chain for every booking is eight to twelve hours a week. A full working day, gone to coordination instead of care.

Run it on your own desk. A coordinator on $28 to $38 an hour, ten hours a week stitching this together, is $280 to $380 every week. North of $15,000 a year for the one job on the roster nobody wants.

The expensive part is the part you cannot see

The hours are visible. What the chain costs when a link breaks is not.

The fund details go missing and nobody chases them, so the check never happens and the patient's limit ran out back in March. The call gets made but the answer never reaches the system, so the desk quotes from memory and quotes wrong. A waiting period is spotted on the phone and then forgotten, the work goes ahead, and the claim bounces. A DVA referral sits unauthorised because that step belonged to no one in particular. Each gap is a few hundred to a few thousand dollars, plus the one you cannot put a number on: a patient you quoted $30 who got charged $150, telling everyone they know.

None of those are call failures. They are coordination failures. The call worked fine. The loop around it did not.

When the whole loop runs without your desk

This is what Heya actually solves. Not one phone call. The loop.

When a patient books, Cordi, Heya's AI, picks it up and runs the chain end to end. It checks the record for the fund and texts the patient if anything is missing. It puts an AI voice agent on the call to Medibank, Bupa, HCF, NIB or whoever is on the card, holds, and asks the questions that decide the gap. It turns the rep's answers into clean fields and writes them straight into your practice management system, Cliniko, Nookal, Best Practice or Dental4Windows, so nobody rekeys a thing. It texts the patient before they arrive: "Hi Sarah, we've confirmed your HCF extras cover for Thursday. Your gap will be $35. See you at 10am." And when cover is short, expired or tangled, it surfaces that to your receptionist with the full context, while there is still time to do something about it.

One booking, handled end to end. Your team touched none of it.

You would not hand your billing chain to a robot on day one. Good.

You should not, and Heya does not ask you to.

Every engagement starts as a pilot on one fund, usually whichever one sends you the most patients. The loop runs alongside your manual checks for four weeks, on your real patients, before a single manual step gets switched off. You watch it land the numbers before you trust it with anything that touches your revenue.

And it knows where it stops. Cordi never reads fund policy or makes a clinical or financial call. It surfaces what the fund actually said and hands the judgment back to you. Anything it is unsure of gets held for a person to confirm before it reaches a patient. The genuinely messy cases still land with your receptionist, only now they arrive with the full context attached, so the call takes two minutes instead of fifteen.

Why this works now

Two things changed. Well over 40% of Australians now carry private health cover, so more patients need verifying before more appointments than ever. And voice AI only recently got good enough to hold a real call with a fund rep without falling over, at a price a small practice can justify. The problem got bigger and the fix got viable at the same moment.

So the honest comparison is not Heya against other software. It is Heya against the coordination you are paying for by hand right now: the wages lost to hold music, the claims that bounce when a step gets dropped, the quiet damage of a patient charged five times the gap you quoted. Set against that, it pays for itself before it does anything clever.

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