Understanding Surgery Fees
Overview of Private Operation Fees
This information is designed to help you understand the complexities of the health system. We endeavour to provide you with as much information prior to surgery as possible. Through the private system you have certainty over who will be doing the procedure (in this case Mr White) and better choice over when the operation is performed.
Costs involved for procedures in the private system generally include:
- Surgeon’s Fees.
- Anaesthetists’s Fees (This is a specialist doctor involved in your procedure. We can provide the details of your specific anaesthetist once a date for surgery is determined).
- Hospital bed and theatre costs. If you have private health insurance this is confined to the excess that is determined by the policy you take out with a specific insurer and the level of cover you choose. Some insurers have no excess for day surgery. In general the insurers offer cheaper annual premiums in exchange for higher excesses when you use the insurance. This is why we recommend contacting your private insurer prior to any admission as we are not able to find out this information on your behalf. We can generally give you an estimate of which item numbers will be used. Please note that some insurers offer lesser policy (Intermediate) cover which are generally cheaper to take out. Unfortunately this means that some procedures which attract a Medicare item number are not covered by the insurer – meaning large out of pocket costs to the patient. Instances may arise where payment is available for removing a skin cancer but not reconstructing it! We advise checking this prior to any procedure.
- Pathology if relevant (Blood tests, histopathology etc) – These tests are also undertaken by specialist trained doctors.
- Implants, prostheses etc.
SURGICAL FEES (Mr White)
e.g. Skin cancer surgery, reconstructive surgery
All (non-cosmetic) surgical procedures are covered by Medicare item numbers. These numbers have associated rebates which determine the amount of money paid for the specific procedure. (As an example – for skin excision there are more than 50 codes excluding any reconstructions that may be necessary). The government through Medicare and private insurers determines the rebates for these codes. Unfortunately the increases since 1983 have not kept up with inflation, let alone the increases associated with running quality medical practices, such as indemnity insurance. These differences between costs and rebates give rise to what is known by most people as the “gap”.
Traditionally a patient would come for a procedure and be given the bill at the post-operative appointment (as the numbers and costs are based on the formal pathology which is available approximately 48 hours later). The patient would then be responsible for the surgical fee in total. This could be anywhere between a few hundred and a few thousand dollars. The actual amount would not be known until after the procedure had been undertaken. The patient would then have to physically go to Medicare and then their insurer to obtain a partial refund of this fee. In practice the gap or out of pocket amount in this setting is often much more than the out of pocket fee we charge. We have decided on a different approach in order to minimise actual out of pocket costs and to provide maximal pre-operative informed financial consent. It is also, we believe, much more convenient for the patient. A fee is charged at the time of booking your procedure – this is your only out of pocket costs for the surgical fee. Following the procedure we then liaise with the private insurer directly to obtain the balance. We feel that this is a more transparent and logistically easier method for the patients.
Different Billing Procedures for Certain Specific Operations Apply
For a sub-group of operations we charge the full surgical and anaesthetic fee upfront and the traditional system of obtaining rebates after the procedure still applies. We provide as detailed a quote as possible after your first consultation.
e.g. breast reductions , revisional breast implant surgery, some upper eyelid surgery, abdominoplasty (tummy tuck) surgery.
You may decide to self fund through the private system but please be aware that the costs are quite significant for this as you will be responsible for all costs including for the theatre and bed. We can provide a quote for this.
For operations with no Medicare item numbers all costs are born by the patient – Surgeon, anaesthetist, theatre, bed, implants, pathology etc. In this setting there is no coverage by either Medicare or private insurers.
It also means that the costs are subject to GST.
We provide as detailed a quote as possible after your first consultation.