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Medicare, Health Fund and Financial Information

Informed Financial Consent and Estimate of Surgical Fees

Once an operation has been booked, you will receive from our practice an Informed Financial Consent with an Estimate of Surgical Fees. This is a legal document for the benefit of the patient, as outlined by the Trade Practices Act and recommended by the Australian Medical Association.

 

The Informed Financial Consent will usually contain:

  • Procedure name(s) and associated Medicare Item number(s).
  • The fee charged by the surgeon.
  • The proportion of the fee charged by the surgeon that is not paid by either Medicare or your private health. This is the gap or out of pocket fee that you will be asked to pay.
  • Declaration and consent by the patient or guardian regarding the amount payable.

Note that as with any medical procedure, if unforeseen circumstances should arise during the procedure it may be necessary to arrange additional medical services. If that happens there may be additional costs to you that are not covered by this estimate.

 

Note also that the estimated fee contained in the Informed Financial Consent does not cover services provided by other doctors that may be involved in your procedure, such as anaesthetists and surgical assistants. The same applies to the costs associated with your stay in the hospital or day surgery unit.

 

Payment for Surgical Procedures

As a private patient you are responsible for the payment of all fees agreed between you and your doctor, as well as hospital charges and fees charged by other professionals usually anaesthetist, surgical assistant and pathologist.

 

If you have private health insurance, the health fund usually pays for the bulk of all fees and you are only required to pay the difference also known as the gap or out of pocket.

 

We use a system called informed gap, where patients are informed before their procedure the difference between the amount charged by the surgeon and the fee paid by the health fund.

 

If you have any questions or concerns, please talk to us. We aim to have a competent, smooth and efficient practice that strives to help our patients achieve the best outcomes and that includes making our clients comfortable that they are being charged a fair and reasonable amount for their treatment.

 

Why there is a Gap?

The amount to be paid for medical/surgical procedures is decided by the government under its Medicare Benefits Schedule. Medicare benefits are based on a list of standard fees for medical services. Medicare normally pays 75% of the schedule fee for in-hospital services. Private Health Funds typically pay the other 25%.

 

Over almost 30 years the increases in Medicare rebates have not kept pace with inflation or the cost of living, while the costs of running a modern specialist practice have increased significantly.

 

Data published by the AMA shows that Medicare schedule fees have increased by about half of other indices such as the CPI or Average Weekly Earnings.

 

 

The real reason for gaps is the failure of Government to adequately increase the Medicare rebate.

 

Each year the AMA publishes a schedule of fees that are considered appropriate remuneration for various procedures and consultations. The prices charged by our practice reflect the fees proposed by the AMA.