FEES

Financial Considerations

We consult and operate in both the public and private sectors. It is important that you understand what, if any, financial obligations you may incur before you have any treatment.

Consultations

We consult privately insured patients in our private rooms at Hollywood Consulting Centre. A map can be found at the bottom of this page. Our fees for the initial, post-operative and follow-up consultations can be obtained by ringing our rooms at Hollywood Consulting Centre (08 6389 0244).

Surgery

Public patients

All Australians with a Medicare card are entitled to receive treatment in the public sector. This treatment is free to the patient. We operate and consult on public patients at Sir Charles Gairdner Hospital and Osborne Park Hospital. All public patients will need to be seen in one of these two hospitals.

Visitors from some overseas countries requiring emergency treatment may be eligible for free care under Medicare. This facility is only available to countries that have a reciprocal agreement with the Australian government, and is normally restricted to genuine emergencies.

Private patients

Insured patients

Depending on your health fund there may be a ‘gap’ payable for a surgical procedure. In most circumstances this will be within the ‘known gap’ arrangement of your health fund. You will be provided with a written quote of any out of pocket (‘gap’) payments prior to your surgery.

Australian patients may hold insurance through one of the Australian Health Funds. There are almost 50 Health Funds that offer many different policies that can further be adjusted to meet individual requirements (e.g. an excess). We cannot know the exact details of your policy. It is your responsibility to contact your Health Fund and determine exactly what will or will not be covered by your policy. In particular you need to understand if you will have a 'gap'. We will be pleased to provide you with any information, and in particular the operation item number, you may require.

Please note we have no control over what other providers may charge. We will provide you will as much help as we can, but ultimately it is your responsibility to understand what your Health Fund will, or will not, cover. See 'the gap' below.

It is a legal requirement of various Health Acts, and a condition of your Health Fund policy, that (i) you are advised, preferably in writing, about your likely costs, and (ii) that you acknowledge receipt of this information.

Uninsured patients

We are a private specialist practice and therefore do not see uninsured patients in our rooms. If you wish to see our surgeons in the public sector you will require a referral to The Colorectal Department at either Sir Charles Gairdner Hospital or Osborne Park Hospital.

The gap

The issue that causes the greatest concern for insured patients is ‘the gap’. That is the difference between what the doctor charges, and what is covered by the Health Funds or Medicare. A brief outline of the gap is provided below. If you require more detailed information you should consult the websites of the Australian Medical Association and the Federal Department of Health and Ageing.

Background to ‘the gap’

The government underwrites a proportion of a doctor’s private fee through the CMBS. By the government’s own admission the CMBS is related to what the country can afford and not the real cost of the services. Since 1980 the Consumer Price Index (CPI) has increased more than twice the rise in the CMBS. Medical inflation is consistently greater than general inflation. Medical providers have been unable to absorb these increasing costs and their fee for almost all services now exceeds the CMBS. The difference between the providers’ fee and CMBS is known as the ‘gap’.

Health Funds, the Australian Medical Association, Workers Compensation insurance and all other health care providers recognize that the CMBS fees are unrealistic and their benefits are much greater than the CMBS. If a medical provider charges within the patient’s Health Fund scale of benefits the patient will have no out of pocket expenses. This is a ‘no gap’ arrangement. If a medical provider charges above the patient’s Health Fund’s scale of benefits the patient has to pay the excess fee. If this excess is discussed prior to the treatment it is called a ‘known gap’. If patients are charged a ‘known gap’ some funds will still pay their full benefit so the patient will only pay a small ‘known gap’. Other funds will only pay the CMBS benefit so the patient will have to pay a much larger ‘known gap’.

Western Australian patients should be aware that HBF, WA largest Health Fund, will normally only pay the CMBS fee if there is a ‘gap’. This means that if a provider charges above HBF’s fee schedule, HBF will only pay the CMBS fee. These patients will have a much larger gap compared to the gap they would pay if they were insured with another Health Fund. It is legal requirement that Health Funds help you change provider if you so request. Provided your insurance is up to date this has to be done without delay and at no cost to the insured.

Surgeon

Anaesthetist

Anaesthetists have a different set of fee scales. We do not know what they will charge you. By law we are prohibited from asking the anaesthetist to charge you a ‘no gap’ fee. Many patients only meet their anaesthetist on the day of surgery. This is not a good time to discuss their fee, especially if there is a gap and they have to provide you with written informed financial consent (as required by law). Your anaesthetist will be known well in advance. Our secretaries can give you the anaesthetist’s contact details, the estimated duration of the operation and the item number(s). We encourage you to discuss their likely fee with them prior to your surgery.

Hospital

The extent of your hospital cover will be determined by your policy. Patients and Health Funds agree numerous variations to many different policy types. We cannot advise you on whether you will have a ‘hospital gap’. Our secretaries can give you the required item number(s) and you should contact your Health Fund directly.

Other providers

It is possible that, in addition to the above fees, you may also receive an account from other providers. This will depend on the magnitude of your surgery, the post-operative course and your medical background. These providers may include a physician, radiologist, intensivist, pathologist and ancillary services such as physiotherapists, pharmacy etc. It is often not possible to anticipate which, if any, of these providers you may require, nor the fees that may be charged. In many cases doctors are prohibited by law from discussing their fees.

Estimates

It is important to recognise any quotes can only be estimate. The operation may be less or more complex than anticipated. You may then be due a refund, or will have an additional amount to pay. This is like a ‘variation’ when building a house. However, as you will be anaesthetised you cannot be advised of the variation until after it has occurred.

Your responsibility

It is your responsibility to ensure that you have a clear understanding of the financial implications of your operation prior to your surgery. If you wish to clarify any financial aspect of your proposed treatment please contact our secretaries, or make a further appointment to see us.