An Explanation of Fees
The standard fees charged by our rooms 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.
If you have any questions it is important that you ask about this gap. Our staff are fully informed with charges and rebates and will be able to help you navigate through what can be a complex process. These fee explanations can cover:
- Consulting Fee
- Surgical Fee
- Treatment Estimates
If you require more information, please do not hesitate to call the practice during office hours.
Other Possible Disbursements
There may be other charges involved in your care. You need to also check with your health fund to see what is covered for additional areas of service. Potential areas of cover are:
- Surgical Assistants
- Implants or Prosthesis
- Tests (Radiology, Pathology)
- Post-Operative Care
We offer informed financial consent to all our patients prior to surgery. This is a pre-treatment estimate of your surgical costs.
If you choose to be treated as a private patient, you will be treated at either Nepean Private Hospital, Penrith or Macquarie University Hospital, Macquarie University. After discharge, your care will be carried out in either an outpatient clinic (e.g. physiotherapy) or in my private rooms or will be referred to your local general practitioner.
Types of Private Patients
This practice caters for a range of Private patients, these include:
- Private Health Insured
- Department of Veterans Affairs (DVA)
- Self-Insured (Uninsured)
Private Health Insurance
Private Health Insurance allows you and your family to access the right health services at the right time. You have control of your health care and can choose the provider, facility and timing of your treatment.
Depending on your level of cover, some health funds also require you to pay an excess. We are not responsible for these costs but our staff will do their utmost to guide you through the process.
Our practice accepts most private health insurance programs. Our staff can also help with your claim for benefits, but we remind you that your specific policy is an agreement between you and your insurance company.
Please keep in mind that you are responsible for your insurance coverage. Please confirm with your health fund that you are covered for the “condition” for which you are being treated.
Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with the AMA fee schedule.
You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months. In most cases, we can lodge the claims for you.
Department of Veterans Affairs (DVA)
The Australian Government’s Department of Veterans’ Affairs (DVA) provides support to current and former serving members and their families through a range of benefits (including ongoing or one-off payments). For further understanding on how you can apply these benefits to our service and the scope of cover please refer to: http://www.dva.gov.au/benefits-and-payments
Patients may be able to choose private admission even if they do not have private health insurance. Self-funded patients will be liable to pay the following:
- The gap between the Medicare benefit and any specialist’s charge
- The gap for diagnostic services (medical imaging and laboratory), however some of these services may be bulk billed to Medicare, that is no ‘gap’
- Hospital accommodation fees (bed charge)
- Surgically implanted prostheses
Essentially this means you must meet all costs of the admission yourself except those covered by Medicare.
For further information about being a private patient, and an itemised quote, please contact our rooms.
Non-Reciprocal Health Care Agreement - If you are an overseas patient from a country where there is no Reciprocal Health Care Agreement, you are not eligible for Medicare and you are responsible for payment of all fees and services. Non-Medicare patients are billed for inpatient and outpatient services regardless if they choose public or private admission.
Reciprocal Health Care Agreement - If you are a visitor from a country where Australia does have a Reciprocal Health Care Agreement (RHCA), you may be eligible for treatment that is deemed immediately necessary for any health problem or injury whilst in Australia. RHCA does not cover pre-arranged or elective treatment. Overseas patients who are covered by the RHCA will not be covered if they choose private admission.
Please contact us for more information.
Private vs Public Fees
You may choose to be a public or a private patient.
Public Hospital Patients:
Australian residents who decide to be a public patient are entitled to free treatment under Medicare. I now only work in the private sector. If you wish to be treated as a public patient, your GP can refer you to an orthopaedic outpatient clinic at a public hospital. 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.
In the public hospital, the surgery is often performed by a registrar (doctor training in orthopaedic surgery) but the registrar is supervised by a senior surgeon who is responsible for your care.
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.
Private Hospital Treatment:
In the private system, I will perform your surgery personally and will also look after you post-operatively whilst an in-patient. All follow up appointments will be in my office, or optionally via phone appointments if you live in the country.
Our reception staff will be happy to advise you of the consultation fee upon booking an appointment.
- Surgical fees are billed directly to the Health Insurance Providers.
- An out of pocket co-payment may be required. The amount can vary depending on the type and complexity of surgery or procedure. Patients will be advised, in writing, after the consultation, of the amount of gap payment.
- Fees for uninsured patients are advised by the reception staff upon request.
How to Pay?
For your convenience, we accept a number of payment methods in the rooms, by post and online:
- Credit Card: VISA, Mastercard
- Electronic - EFTPOS
No Private Health Insurance
If you are not in a Private Health Fund or DVA and you need surgery, you have two alternatives:
- Go on a Waiting List at the Public Hospital, or
- Pay for the operation yourself ("Self-Insure")
However, the Waiting List for operations in the Public system can be long. It is best to check with your GP regarding the situation in your local area.
An increasing number of people are choosing to "Self-Insure" or pay for their own surgery, so they don't have to wait. This is often a worthwhile investment as it means you can have your operation done straight away or whenever it suits you. This can allow you to get back to your work and sport as soon as possible.
All the private hospital fees associated with your surgery are an out-of-pocket expense, but we will assist you in obtaining an estimate of costs from the private hospital before you go ahead with your surgical procedure.
Call my practice and they will be happy to provide you with an accurate costing. A proportion of my fees and the anaesthetic fees attract a rebate from Medicare.
If you require more information, please do not hesitate to call us during office hours.