Payment Types
About Private Fee Patients
Our practice treats private fee patients.
If you choose to be treated as a private patient you will be able to:
- choose your own treating specialist, and
- be treated at hospitals that our doctor is affiliated to or is a visiting medical specialist,
After discharge, your care and follow up appointments will be carried out by your specialist and team in either
- an outpatient clinic or in our private rooms, or
- will be referred to your local general practitioner.
As a private patient our surgeon will perform your surgery personally and will also look after you if you are advised to be an in-patient. All follow up appointments will be in our private rooms.
Overview of Payment for Patients
This page explains of practice and payment policies relating to:
- the billing types our practice offers,
- the billing policies for our medical services, and
- further explanations to common fee questions patients have.
Types of Patients
Our practice treats the following types of private patients:
- Privately Insured Patients,
- Insurance Patients (Workers Compensation, Motor Accidents etc),
- Veteran Affairs Patients,
- Self Insured Patients, and
- Overseas Patients.
Fee Estimates
We offer informed financial consent to all our patients prior to surgery. This is a pre-treatment estimate of your surgical costs.
While the fees charged may depend on the specific course of treatment, our practice's standard fees are in line with the Australian Medical Association recommended fee schedule. This means that in most instances there will be a ‘gap’ between our surgical fee and what is covered by Medicare and your health insurance fund.
The pre-treatment fee estimate includes the specific item numbers to be used and enables you to discuss with your health insurance company what you are covered for and if benefits are applicable.
If there is any problem with either the fee estimate or any other billing issue, it is important that you ask our staff. They can help you navigate what can be a complex process by either advising and helping explain the charges and rebate structure.
All Fee Categories
Our practice fees for either Consulting or Surgery may sometimes only be part of your treatment cost.
Other possible fees or disbursements involved in your care are dependant on which course of action is chosen for your treatment. You may need to also check with your health fund to see what is covered for additional areas of service. Potential fee categories to be sure of can include:
- Hospital Fees,
- Surgical Assistant Fees,
- Implants or Prosthesis Costs,
- Anaesthetists Fees,
- Diagnostic Tests (Radiology, Pathology), and
- Post-Operative Care.
Questions to Ask Your Health Fund
When talking with your Health insurance company you should be clear on the following matters:
- What is my annual monetary benefit limit for:
- General Surgical treatment and Major Surgical treatment?
- What service limits apply to my cover?
- When does my annual benefit limit expire?
- Do I have a waiting period? And when does it end?
- What kind of Surgical treatment is NOT covered?
About Our Fee Policy?
The medical fee rebate system in Australia is complex. A set of fees for medical services is determined by the Federal Government and known as the Medicare Benefits Schedule (MBS). Most procedures involved in your treatment will have a MBS “item number” and the Government sets a Medicare Benefits Schedule (MBS) fee for each item number.
The MBS fee is used to work out how much Medicare will pay. Medicare pays a benefit of 75% of the MBS fee for in-hospital treatment and 85% of the MBS fee for out-of-hospital services. MBS fees are not the fees doctors charge, they are fees set by the government to manage the benefits paid by Medicare.
Surgeons are free to set their own fee for the services, these are also governed by the The Competition and Consumer Act 2010 but are under no obligation to charge fees that are equal to the Medicare Benefits Schedule (MBS) fee or the schedules of medical benefits set by private health insurers.
Our fees not only take into account the professional fees but many other factors including practice staff, office expenses, operating expenses, medical registration, compulsory professional association subscriptions, professional indemnity insurance and many other elements. These cost can vary significantly, yet the Medicare rebates are identical irrespective of the practice running costs.
In our practice specialty, prompt communication with the referring general practitioners is vital, and prompt responses, with high staff levels is a major benefit to patient care, but also adds cost.
Surgeons should satisfy themselves in each individual case as to a fair and reasonable fee having regard to their own costs and the particular circumstances of the case and the patient.
The same operative procedure can vary enormously in both complexity and operating time between individual patients, and as such there may be significant variations in the operation fee for the same procedure, depending on the individual circumstances. For this reason sometimes it may not be possible for us to provide estimates for operative procedures over the phone prior to a clinical consultation.
Medicare Gap for Out Patient Services?
The Medicare Rebate for an outpatient service is 85% of the MBS schedule fee.
The “gap” between the amount charged and this 85% rebate is not covered by your private health insurance for outpatient services and therefore a financial obligation on yourself arises, and you will face an “out-of-pocket” charge.
As a patient you pay 15% of the MBS fee, plus any amount charged by the doctor over the MBS fee. Private health insurers are not allowed to provide cover for doctors’ fees for out-of-hospital services.
Medicare benefits levels are fixed arbitrarily by the federal government and benefit levels have not kept pace with inflation, the escalating costs of running a practice and increasing medical indemnity premiums, thereby widening the gap between reasonable fees and Medicare benefits.
The fees charged by our practice have been determined after careful study and investigation of practice costs and other relevant and material circumstances, and are considered as being fair, reasonable and appropriate for the services provided.
No Gap, Low Gap and Known Gap Policy
Our practice believes strongly in the importance of appropriate surgical care. We offer clear fee schedules for our patients, with service fees ranging across
- No Gap
- Low Gap, and
- Known Gap
Every person who has surgery cover with any Australian health fund and who are in significant financial hardship may be covered by our No Gap Policy. This means some patients may receive no out-of-pocket expenses for some treatments .
We also offer a “No Gap Surgical Check Up”. This includes:
- Surgical examination and a consultation to address any and all of your questions and concerns regarding some specific conditions.
- Diagnostic examinations, and
- Where surgery is required, this may also be covered by our No Gap Policy
Conditions for the No Gap Surgical Service include you must have:
- Basic Surgical cover with your private health insurer,
- Your health fund card with you at the appointment,
- Insurance cover for the cost of the treatment. If your limit is reached for services provided or your health insurer paid zero dollars, you will have to pay the difference.
Where you are not eligible for No Gap services, you may also be eligible for Known Gap or Low Gap Fee Schedules. Please contact our practice for further details.
Uninsured Public Patients
If you are not covered by private health insurance or other claiming system and your require surgery there are two alternatives:
- Go on a Waiting List at the Public Hospital, or
- Pay for the operation yourself ("Self Insure")
Australian residents who decide to be a public patient are entitled to free treatment under Medicare. Your treatment will be carried out by an appropriate specialist which will be arranged prior to your admission. After discharge, your care will either be continued in an outpatient clinic or you will be referred to your local general practitioner.
There are no fees for surgery in the public hospital, however, there is a waiting list. Your position on the waiting list will be based on the severity of your condition. Your follow up visits after surgery will be arranged through the hospital.
In the public hospital the surgery is usually performed by a registrar (doctor training) but the registrar is supervised by a senior surgeon who is responsible for your care.
Public Hospital Waiting List
The Waiting List for operations in the Public Hospital System can be considerable, currently many common procedures are upwards of twelve months.
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