Insured, Non-Insured, Super Fund
Insured
Overview
This document provides information on the following subjects:
- An Explanation of Fees
- Private Patients
- Payment Policy
- Tax Refund Scheme
- No Private Health Insurance
An Explanation of Fees
Our standard fees charged for Operations are based on those recommended by the Australian Medical Association. 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 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.
Non-Insured
If you are not in a Health Fund, and we have decided you need surgery, you have two alternatives:
- Pay for the operation yourself (“self insure”) which may include accessing your Superannuation Fund (see below), or
- Join a Health Fund, understanding there may be a wait for pre-existing conditions until you have been a member for a period of time.
Self Insured
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.
The costs may not be as high as you think, especially for some less invasive surgeries like
- Arthroscopy
- ACL Reconstruction
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 small rebate from Medicare.
If you require more information, please do not hesitate to call us on during office hours.
Super Fund
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.
