Dr.Roger Brighton

Insured

Overview

This document provides information on the following subjects:

  • An Explanation of Fees
  • Private Patients
  • Public vs Private
  • Payment Policy
  • Tax Refund Scheme
  • No Private Health Insurance

An Explanation of Fees

The standard fees charged by our rooms are below the Australian Medical Association recommended fee schedule. However, in most instances there will still be a ‘gap’ between our surgical fee and what is covered by Medicare and your health insurance fund.

If there is any problem with this, it is important that you ask about this gap. Our staff are fully informed about 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 depending on which course of action you choose. You need to also check with your health fund to see what is covered for additional areas of service. Potential areas of cover are:

  • Hospital
  • Surgical Assistants
  • Implants or Prosthesis
  • Anaesthetics
  • Tests (Radiology, Pathology)
  • Postoperative Care

Estimates

We offer informed financial consent to all our patients prior to surgery. This is a pre-treatment estimate of your surgical costs. This estimate enables you to check with your health insurance company what is covered and what is not covered by your policy.

Private Patients

Overview

If you choose to be treated as a private patient, you will be treated at hospitals with which I am affiliated or hold rights as a visiting medical officer (VMO). After discharge from hospital, there will be follow-up visits in my private rooms.

Types of Private Patients

This practice caters for a range of Private patients, including:

  • Private Health Insured
  • Department of Veterans Affairs (DVA)
  • WorkCover
  • 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. With the security and protection of private health insurance, you have access to an extensive range of private hospitals and can rest assured that your health is in good hands.

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 to better understanding.

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 total obligation should your insurance benefits result in less coverage than anticipated.

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.

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

Self Insured (Uninsured)

Patients can 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
  • Dental Services

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, contact our rooms

Overseas Patients

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. This page provides patients with the different options for surgery in the private or public hospital system.

Public Hospital Patients:

Australian residents who decide to be a public patient are entitled to free treatment under Medicare. Your treatment will be carried out under the direction of an accredited 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 (Orthopaedic doctor in training) 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 whilst you are an in-patient. All follow-up appointments will be in my office, the first of which is covered by your surgical fee.

Payment

Overview

Our reception staff will be happy to advise you of the consultation fee upon booking an appointment over the telephone. Payment on the day of consultation is much appreciated.

Should surgery be advised:

  • Surgical fees are billed directly to the Health Insurance Providers.
  • In many cases, there are also “gap fees” (extra amounts which are not covered by your health fund) which vary depending on the type and complexity of surgery or procedure. Patients will be advised, in writing, after the consultation, the amount of any gap payment.
  • Fees for uninsured patients are advised by the accounts manager upon request.

How to Pay?

For your convenience we accept a number of payment methods in the rooms, by post and online:

  • Cheque and Cash
  • Credit Card: VISA, Mastercard, Amex (logos),
  • Electronic other - (Credit Card, EFTPOS, BPay)

Early Release of Superannuation

Patients may apply to Centrelink for an early release of superannuation funds to cover part or all of the costs involved. More details can be found on the Centrelink website.

If you chose to apply for this, three documents need to be lodged:

  • Completed application form - click here to download
  • A letter of support from your General Practitioner
  • A letter of support from our clinic (we will provide this after your initial consultation)

Please note that processing time by Centrelink generally takes around 3 weeks, and allow a further 4-6 weeks for your superannuation fund to release the funds to your personal bank account.

HSS Orthopaedics Hospital for Specialist Surgery
Suite 1, Level 1, 17-19 Solent Circuit, Bella Vista NSW 2153
Central West Orthopeaedics &
Sports Injuries
Westmead Specialist Centre
Suite 12, Level 1, 16 -18 Mons Rd, Westmead NSW 2153