Informed Financial Consent
For routine surgery, Dr Ball's office will provide an estimate of medical fees as part of 'Informed Financial Consent'. If you have concerns or questions about the quotation or your ability to pay, please contact our office to discuss your options.
You will also be given the opportunity to obtain an estimate from the anaesthetist involved in your surgery. Before surgery, you should contact your private health fund to ensure an adequate level of coverage for hospital admission and surgery.
In emergency situations, it is not always possible to obtain informed financial consent. You will be informed of the fees incurred at the earliest appropriate time.
Out of Pocket Expenses - 'The Gap'
Fees charged for surgeries in private hospitals may be greater than that reimbursed by Medicare (MBS) and private health insurance. In this situation, patients will have 'out of pocket' expenses or gap.
'No Gap' and 'Known Gap' Insurance
Most private health funds now offer the option of 'no gap' or 'known gap' coverage - they agree to cover the gap to pre-determined or pre-agreed levels. The amount of coverage varies between funds and may not always be sufficient. If you wish to explore this option, please contact our office.
Why is this so?
Medicare publishes a schedule of fees (MBS schedule). For private inpatient services, Medicare will only refund 75% of the MBS fee and private health insurance covers the remaining 25%.
The Medicare (MBS) fees have not risen with rising prices. The graph below, illustrates the increase in prices (CPI - green line) and average weekly earnings (AWE - blue line) since 1985. The Medicare fees (MBS - red line) have not kept up. The recommended Australian Medical Association fees (AMA - mauve line) are a fairer reflection of the rising costs of medical practice.
source : Australian Medical Association, 2008 (http://www.ama.com.au)