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FEES

Financial Considerations
We consult and operate in both the public and private sectors. It is important that you understand what, if any, financial obligations you may incur before you have any treatment.

Consultations
We consult in our private rooms at Hollywood Specialist Centre. A map can be found at the bottom of this page. Our fees for the initial, post-operative and follow-up consultations can be obtained by ringing our rooms at Hollywood Specialist Centre (08 6389 0244).

Surgery

Public patients

All Australians with a Medicare card are entitled to receive treatment in the public sector. This treatment is free to the patient. We operate on public patients at Sir Charles Gairdner Hospital (Rupert and Andrew) and Osborne Park Hospital (Andrew only). Once it has been agreed that you need surgery you will be placed on the waiting list of the hospital that is most convenient to you.

Visitors from some overseas countries requiring emergency treatment may be eligible for free care under Medicare. This facility is only available to countries that have a reciprocal agreement with the Australian government, and is normally restricted to genuine emergencies.

Private patients

Any person can be treated as a private patient. Private patients will normally fall into one of two groups.

Insured patients

With few exceptions we are a 'no gap' (see below) provider.

Australian patients may hold insurance through one of the Australian Health Funds. There are almost 50 Health Funds that offer many different policies that can further be adjusted to meet individual requirements (e.g. an excess). We cannot know the exact details of your policy. It is your responsibility to contact your Health Fund and determine exactly what will or will not be covered by your policy. In particular you need to understand if you will have a 'gap'. We will be pleased to provide you with any information, and in particular the operation item number, you may require.

Please note we have no control over what other providers may charge. We will provide you will as much help as we can, but ultimately it is your responsibility to understand what your Health Fund will, or will not, cover. See 'the gap' below.

It is a legal requirement of various Health Acts, and a condition of your Health Fund policy, that (i) you are advised, preferably in writing, about your likely costs, and (ii) that you acknowledge receipt of this information.

Uninsured patients

Some patients who do not have private insurance may wish to be treated as an uninsured private patient. This will include most overseas patients.

Modern medical care can be very expensive. Before being admitted as an uninsured private patient you should give the financial implications very serious consideration. Normally admission as an uninsured private patient is only an option for small, simple operations that can be managed as a day case or with one over night stay. In general we do not admit patients who are likely to have a complex operation as an uninsured private patients as the financial uncertainties are too great.

If you wish to be admitted as an uninsured private patient we will provide you with the following information:

The gap
The issue that causes the greatest concern for insured patients is ‘the gap’. That is the difference between what the doctor charges, and what is covered by the Health Funds or Medicare. A brief outline of the gap is provided below. If you require more detailed information you should consult the websites of the Australian Medical Association of the Federal Department of Health and Ageing.

Background to ‘the gap’

The government underwrites a proportion of a doctor’s private fee through the CMBS. By the government’s own admission the CMBS is related to what the country can afford and not the real cost of the services. Since 1980 the Consumer Price Index (CPI) has increased more than twice the rise in the CMBS. Medical inflation is consistently greater than general inflation. Medical providers have been unable to absorb these increasing costs and their fee for almost all services now exceeds the CMBS. The difference between the providers’ fee and CMBS is known as the ‘gap’.

Health Funds, the Australian Medical Association, Workers Compensation insurance and all other health care providers recognise that the CMBS fees are unrealistic and their benefits are much greater than the CMBS. If a medical provider charges within the patient’s Health Fund scale of benefits the patient will have no out of pocket expenses. This is a ‘no gap’ arrangement. If a medical provider charges above the patient’s Health Fund’s scale of benefits the patient has to pay the excess fee. If this excess is discussed prior to the treatment it is called a ‘known gap’. If patients are charged a ‘known gap’ some funds will still pay their full benefit so the patient will only pay a small ‘known gap’. Other funds will only pay the CMBS benefit so the patient will have to pay a much larger ‘known gap’.

Western Australian patients should be aware that HBF, WA largest Health Fund, will normally only pay the CMBS fee if there is a ‘gap’. This means that if a provider charges above HBF’s fee schedule, HBF will only pay the CMBS fee. These patients will have a much larger gap compared to the gap they would pay if they were insured with another Health Fund. It is legal requirement that Health Funds help you change provider if you so request. Provided your insurance is up to date this has to be done without delay and at no cost to the insured.

Surgeon

In almost all cases we will charge you the benefit set by your Health Fund. You will then have ‘no gap’ for the surgical fee. In two instances my fee may be greater than the benefit set by your Health Fund. In both instances you will have to pay a ‘known gap’. These instances are (i) a small number of specialised or complex operations and (ii) if your Health Fund is one of those with a low benefit scale. In these cases our fee will usually be the benefit paid by Medibank Private, Australia’s largest Health Fund. You will be given a quote that will include the required item number(s) and the fee. You should then contact your Health Fund directly to determine the estimated ‘known gap’ for your surgical fee.

Anaesthetist

Anaesthetists have a different set of fee scales. We do not know what they will charge you. By law we are prohibited from asking the anaesthetist to charge you a ‘no gap’ fee. Many patients only meet their anaesthetist on the day of surgery. This is not a good time to discuss their fee, especially if there is a gap and they have to provide you with written informed financial consent (as required by law). Your anaesthetist will be known well in advance. Our secretaries can give you the anaesthetist’s contact details, the estimated duration of the operation and the item number(s). We encourage you to discuss their likely fee with them prior to your surgery.

Hospital

The extent of your hospital cover will be determined by your policy. Patients and Health Funds agree numerous variations to many different policy types. We cannot advise you on whether you will have a ‘hospital gap’. Our secretaries can give you the required item number(s) and you should contact your Health Fund directly.

Other providers

It is possible that, in addition to the above fees, you may also receive an account from other providers. This will depend on the magnitude of your surgery, the post-operative course and your medical background. These providers may include a physician, radiologist, intensivist, pathologist and ancillary services such as physiotherapists, pharmacy etc. It is often not possible to anticipate which, if any, of these providers you may require, nor the fees that may be charged. In many cases doctors are prohibited by law from discussing their fees.

Estimates

It is important to recognise any quotes can only be estimate. The operation may be less or more complex than anticipated. You may then be due a refund, or will have an additional amount to pay. This is like a ‘variation’ when building a house. However, as you will be anaesthetised you cannot be advised of the variation until after it has occurred.

Your responsibility
It is your responsibility to ensure that you have a clear understanding of the financial implications of your operation prior to your surgery. If you wish to clarify any financial aspect of your proposed treatment please contact our secretaries, or make a further appointment to see us.

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