Here we explain our medical billing process in the most transparent way.
Our practice is proud to offer a premium service in the treatment of our patients. Unfortunately, without medical fees medical services cannot be provided. Providing the highest quality standards will incur costs.
Generally, we charge fees as recommended by the Australian Medical Association.
Patients will need to cover the gap costs. A 'gap' is the amount you pay either for medical or hospital charges, over what you get back from Medicare or private health insurer. While we are trying to minimise gap payments, our priority is to provide a great service.
Unfortunately, without a gap payment, many practices would not be able to maintain their high level of standards. Gap payments also apply to other specialists such as anaesthetics, pathology services or the surgical assistant.
Patients who are not privately insured can have surgery in a private hospital. However, the same costs apply and will need to be paid by the patient upfront.
What fees can I expect?
1. Initial consultation
You will find the amount of the initial surgical consultation fee in your letter that we send or email to you upon confirmation of your appointment with Dr Obermair. This fee is payable at the time of your consultation and parts of this fee can be claimed back from Medicare and your private health fund. Patients who are referred are virtually always seen for their initial consultation within 5 working days of contacting us.
This consultation fee typically covers:
- the tracing and review of prior medical and surgical reports prior to your appointment (such as histopathology, medical imaging, etc.),
- capturing and processing of your details for medical administration,
- medical review by our practice doctor and Dr Obermair,
- physical examination and a conversation about clinical management and treatment options,
- all bookings (hospital, anaesthetist, surgical assistant, pathology, etc.)
- a clinical management plan including further diagnosis (if needed) and treatment
- prompt communication back to your referring doctor
2. Surgical fees
If you require surgery:
- You will be given a cost estimate based on the expected Medicare item numbers that could be used.
- Gap payments (as explained above) are normally required.
- For patients who require complex pelvic surgery with a high-risk of postoperative issues we charge higher fees.
- The final surgical fee may differ from the estimate (e.g., actual invoice can be higher or lower) due to the nature of medical conditions being only partially foreseeable. While we estimate the surgical fees to the best of our abilities, in such a case, I ask patients to accept that a cost estimate may be imprecise.
- All patients are required to confirm their surgical booking with a deposit preoperatively. The deposit will come off the total bill.
- Separate invoices that patients can expect will come from the anaesthetist, the surgical assistant, pathology (for blood tests and histopathology) and medical imaging (CT scans, X-rays). Typically, patients will need to pay for those invoices and private health funds will reimburse for the majority of those fees.
- Hospital costs
- Patients who do not have private health cover will have to pay a separate hospital bill that includes charges for operating theatre and the hospital bed on the ward.
- For privately insured patients, typically a capped amount is payable prior to hospital admission.
- Patients who are not in a private health fund will need to pay all fees upfront.
Part of your surgical bill will be covered by Medicare and another part will be covered by your private health fund (if you are privately insured). In Australia, every surgical procedure is assigned an item number by Medicare and your health fund. In case of complex surgery, more than one item number will be billed. The item number attracting the highest surgical fee will be charged fully. The second most expensive item number will be billed at half the listed fee and all further item numbers are billed at 25% of the original fee. All items will be displayed in your invoice.
3. Follow up consultations
If you need to see Dr Obermair every three, six or twelve months after surgery (e.g. after chemotherapy, or radiation treatment), a fee for each follow up visit will apply. This fee is less than half of the initial consultation fee and is partially rebatable from Medicare.
Our practice doctor Dr Robyn Huttenmeister will contact every patient post-surgery and is freely available to provide advice with common postsurgical issues. Patients who are known to Dr Obermair have access to an after hours’ phone service. Prof Obermair or one of his equally skilled representatives will be available 24/7, on weekends and when Prof Obermair is on leave.
After surgery an invoice is sent to the patient, which can be paid in full then claimed from Medicare and your private health fund.
Alternatively, our practice can submit your claim to Medicare, and the patient submits the remainder of the bill to the health fund. The patient is then responsible for the remainder of the gap amount.
We expect payment of our invoice within 30 days.
Our practice does not participate in the no-gap or known-gap scheme as often advocated by health funds, because it would not allow us to run a viable practice.
We accept payment by EFTPOS, VISA card, MasterCard, AMEX card, cash, or direct deposit. There are no credit card surcharges.
If we do not receive payment or hear from you after 30 days we will send you a friendly reminder. If patients don’t respond to previous attempts of contact, we will forward the matter to a debt collector and the patient will be responsible for those additional fees plus the outstanding debt.
FAQs about fees
Why do we not directly bill the health fund?
We don’t normally charge the health fund directly because there is a large number of health funds in Australia and every one of them has different reimbursement policies. It would also mean that different health funds would pay different amounts for the same service. It would also mean that health funds would largely determine the value of our service and the service would gradually become more expensive.
In our practice, we have a direct relationship with our patients. It is up to the patient and her family what health fund she chooses. Some patients chose a health fund that requires payments of small premiums only (often these products are referred to as “Top Cover” (or similar) by their health fund) and these health insurance types sometimes require higher gap fees. By contrast, other patients pay higher premiums attracting no or smaller gap payments.
Can I switch health fund immediately prior to surgery?
Yes, you can switch health fund even the day before your surgery in order to obtain a better deal. However, you can only switch within similar health insurance products. A waiting period would apply if you were to switch into a higher insurance category.
Speak to our staff
Estimating the costs for treatment can be complicated. Our staff will do their best to help you understand the costs. Please do not hesitate to call us if you have financial questions about your surgery and treatment.