- An Explanation of Fees
- Private Patients
- Public vs Private
- Payment Policy
- No Private Health Insurance
The standard fees charged by our rooms are in line with the Australian Medical Association recommended fee schedule. This means that in most instances there will be a 'gap' between our surgical fee and what is covered by Medicare and your health insurance fund.
If there is any problem with this, it is important that you ask about this gap. Our staff are fully informed concerning charges and rebates and will be able to help you navigate through what can be a complex process. These fee explanations can cover:
- Consulting Fee
- Surgical Fee
- Treatment Estimates
If you require more information, please do not hesitate to call the practice during office hours.
Other Possible Disbursements
There may be other charges involved in your care depending on which course of action you choose. You need to also check with your health fund to see what is covered for additional areas of service. Potential areas of cover are:
- Surgical Assistants
- Implants or Prosthesis
- Tests (Radiology, Pathology)
- Postoperative Care (e.g. visits with Dr Brighton beyond usual after-care)
We offer informed financial consent to all our patients prior to surgery. This is a pre-treatment estimate of your surgical costs. This estimate enables you to check with your health insurance company what is covered and what is not covered by your policy.
If you choose to be treated as a private patient, you will be treated at hospitals with which I am affiliated or hold rights as a visiting medical officer (VMO). After discharge from hospital, there will be follow-up visits in my private rooms (where you were seen originally).
Types of Private Patients
This practice caters for a range of Private patients, including:
- Private Health Insured
- Department of Veterans Affairs (DVA)
- Self Insured (Uninsured)
Private Health Insurance
Private Health Insurance allows you and your family to access the right health services at the right time. You have control of your health care and can choose the provider, facility and timing of your treatment. With the security and protection of private health insurance, you have access to an extensive range of private hospitals and can rest assured that your health is in good hands.
Depending on your level of cover, some health funds also require you to pay an excess fee. We are not responsible for these costs but our staff will do their utmost to guide you to better understanding.
Our practice accepts most private health insurance programs. Our staff can also help with your claim for benefits, but we remind you that your specific policy is an agreement between you and your insurance company.
Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated.
Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with the AMA fee schedule.
You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.
Department of Veterans Affairs (DVA)
The Australian Government’s Department of Veterans’ Affairs (DVA) provides support to current and former serving members and their families through a range of benefits (including ongoing or one off payments). For further understanding of how you can apply these benefits to our service and the scope of cover please refer to: www.dva.gov.au
Self Insured (Uninsured)
Patients may be able to choose private admission even if they do not have private health insurance. Self-funded patients will be liable to pay the following:
- The gap between the Medicare benefit and any specialist’s charge
- The gap for diagnostic services (medical imaging and laboratory), however some of these services may be bulk billed to Medicare, that is no ‘gap’
- Hospital accommodation fees (bed charge)
- Surgically implanted prostheses
Essentially this means you must meet all costs of the admission yourself except those covered by Medicare.
For further information about being a private patient, contact our rooms
Non Reciprocal Health Care Agreement - If you are an overseas patient from a country where there is no Reciprocal Health Care Agreement, you are not eligible for Medicare and you are responsible for payment of all fees and services. Non-Medicare patients are billed for inpatient and outpatient services regardless if they choose public or private admission.
Reciprocal Health Care Agreement - If you are a visitor from a country where Australia does have a Reciprocal Health Care Agreement (RHCA), you may be eligible for treatment that is deemed immediately necessary for any health problem or injury whilst in Australia. RHCA does not cover pre-arranged or elective treatment. Overseas patients who are covered by the RHCA will not be covered if they choose private admission.
Please contact us for more information.
You may choose to be a public or a private patient. This page provides patients with the different options for surgery in the private or public hospital system.
Public Hospital Patients:
Australian residents who decide to be a public patient are entitled to free treatment under Medicare. Your treatment will be carried out under the direction of an accredited specialist which will be arranged prior to your admission. After discharge, your care will either be continued in an outpatient clinic or you will be referred to your local general practitioner.
In the public hospital, the surgery is usually performed by a registrar (Orthopaedic doctor-in- training). The registrar is supervised, by a senior surgeon, who is responsible for your care.
There are no fees for surgery in the public hospital, however, there is a waiting list. Your position on the waiting list is based mostly on a “first come, first served” policy, but can be varied depending on the severity of your condition. Your follow up visits after surgery will be arranged through the hospital.
Private Hospital Treatment:
In the private system, I will perform your surgery and will attend to your in-patient and post-operative care. Follow up appointments will generally be in my office, the first of which is covered by your surgical fee.
Our reception staff will be happy to advise you of the consultation fee upon booking an appointment over the telephone. Payment on the day of consultation is required.
- In many cases, there are also "gap fees" (extra amounts which are not covered by your health fund) which vary depending on the type and complexity of your surgery. Patients will be advised, in writing, after the consultation, the amount of gap payment.
- Fees for uninsured patients are advised by the accounts manager upon request.
How to Pay?
For your convenience we accept a number of payment methods in the rooms, by post and online:
- Cheque, Cash, Bank Cheque and Money Order
- Credit Card: VISA, Mastercard.
- Electronic other - (Credit Card, EFTPOS, EFT direct to Practice account)
If you are not in a Private Health Fund or DVA and you need surgery, you have two alternatives:
- Go on a Waiting List at the Public Hospital, or
- Pay for the operation yourself ("Self Insure")
I admit patients to the Prince of Wales Hospital where I have regular operating lists.
The care in the public hospital is free of charge to you.
The Waiting List for operations in the Public system is considerable, currently around twelve months. Patients are admitted to hospital on a "first come, first served" basis.
An increasing number of people are choosing to "Self Insure" or pay for their own surgery, so they don't have to wait. This is often a worthwhile investment as it means you can have your operation done straight away or whenever it suits you. This can allow you to get back to your work and sport as soon as possible.
All the private hospital fees associated with your surgery are an out-of-pocket expense, but we will assist you in obtaining an estimate of costs from the private hospital before you go ahead with your surgical procedure.
Call my practice and they will be happy to provide you with an accurate costing. A proportion of my fees and the anaesthetic fees attract a small rebate from Medicare.
If you require more information, please do not hesitate to call us on during office hours.