Once it has been determined that you need an operation, our staff will be able to provide you with a cost estimate for your surgery. This can be a confusing area and the office staff will readily offer you assistance in navigating the financial part of your surgery. This includes help with paper work, hospital admissions, medical fund rebate and the like.
The following information may help make this process easier to understand:
The Medicare Benefits Schedule (MBS) is a listing of the Medicare services subsidised by the Australian Government. It details how much financial assistance the government will provide to assist patients with the cost of health care provided by a private specialist such as an orthopaedic surgeon.
A “gap” is the difference between what the surgeon charges and the Medicare rebate. For surgical procedures, part of this gap is covered by the health insurance provider. The remainder of the gap represents an ‘out of pocket’ expense for the patient.
No Gap Insurance is an agreement between medical specialists and insurance companies whereby the health insurer covers the cost of the health service with no out of pocket expense to the patient for the doctor’s bill.
The AMA Schedule is a listing of recommended fees for medical services that is produced regularly by the Australian Medical association (AMA). The government’s Medicare Benefits Schedule (MBS) has not been indexed to inflation for several decades. AMA fees are approximately equal to MBS fees, but indexed since their introduction. Thus these fees are generally higher than the MBS.
An Item Number is a code which identifies a particular medical service or procedure. These numbers are used to generate accounts for patients, Medicare and insurance companies. A single operation may involve a number of different item numbers depending on the exact nature of the procedure. Item numbers will appear on the preoperative cost estimate for surgery.
Our fees are generally at (or near) AMA rates, but we are happy to negotiate all fees with all patients, especially if their GP indicates a special need for cases of financial hardship. All patients undergoing surgery are given written quotes well in advance, such that gap-fees are known pre-operatively, and again these can be negotiated to agreed figures in the case of special financial requirements.
“No-gaps” schemes are available for selected cases, depending on the circumstances, and all Department of Veterans' Affairs, CTP and Workcover patients are treated at no personal charge for consultations or surgery (CTP and Workcover will need prior written approval).
What if I don’t have private insurance? If you aren’t insured, then Dr. Adie will be able to provide care with two options: