When you make your initial consultation appointment at Melbourne Hip and Knee, our friendly reception staff will advise you of the initial consultation fee along with any Medicare rebates that are applicable. All consultation fees must be paid on the day of your appointment. Preferred methods of payment are credit card or EFTPOS. We discourage payment by cash and do not accept American Express.
If you have a current referral from a GP or another specialist you can claim a rebate through Medicare for your consultation. If you do not have a valid referral you can still attend a consultation, however you will not be eligible for any Medicare rebates. For clinic appointments, your health insurance provider will not assist.
If you are covered by an approved TAC or WorkCover claim we can bill them directly for your consultation and you will only have to pay a small out of pocket fee (no more than $30). For this to occur you must bring all details relating to your claim with you to your appointment. This includes details of the insurance company, a claim number and proof your claim has been accepted. If you do not have all of this information with you, you can still be seen, however you will have to pay the consultation fee in full and get reimbursement from your insurance company later.
In Australia, surgical procedures are performed in both the public and private hospital systems. In a public hospital, health care is free, but you do not get to choose your surgeon or when your surgery is performed. There are often significant waiting times for appointments and for surgery in the public hospital system. In the private hospital system, you are able to choose your surgeon and the timing of your surgery. The down side is the financial cost of your treatment. Your health insurance will apply for most of your hospital treatment but pays little for your cost of surgery.
If surgery is recommended we will provide you with an estimate of the surgeon fees that apply for your procedure, this fee will cover all your in hospital care by your surgeon and follow up in the rooms until six weeks post operatively. This fee is dependent on the exact procedure you require, who you are insured with, and your level of cover. Private Health Insurance only cover a certain level of medical fees. Most charges will exceed these levels so an out of pocket expense will generally be encountered by all patients irrespective of their level of insurance.
If you are a TAC or VWA patient we will write to them to request approval for surgery. Once this is received we will bill them directly for your surgery fees.
Patients covered by travel insurance, overseas health insurance policies and sports insurance policies will generally be required to pay all accounts in full and then claim reimbursement.
If you do not have private health insurance, you can still be treated privately but will be required to pay in full for your surgery.
Surgical Assistant - In most instances your surgeon will require an assistant for your operation. Assistant fees are calculated at a rate of 20% of the surgeon’s fee. Your assistant will invoice you separately for their services.
Anaesthetist - The anaesthetist is the doctor who will put you to sleep for your operation and look after your pain relief afterwards. Your anaesthetist will contact you prior to your surgery to advise you of their fee estimates and any rebates that may apply. Anaesthetic payments are made directly to the anaesthetic service provider.
Physician - Patients who require joint replacement surgery will be required to see a physician to ensure you are medically fit for your operation. They will advise you of their fees when you make your appointment.
Excess - If you have an excess or co-payment on your level of cover, this will be payable directly to the hospital on admission.
We are not able to provide a fee estimate for surgery prior to your initial consultation, as we require details of the specific procedure you require. Settlement of your surgeons account is required prior to your surgery.
What is the Medicare Benefits Schedule?
The Medicare Benefits Schedule (MBS) is a list of procedures and how much financial assistance the government will provide patients with the costs associated with health care provided by a private specialist.
What is a 'gap'?
A gap is the difference between what fee is charged and the Medicare rebate.
For operations, your health insurance provider will pay a portion of the gap.
For clinic appointments, your health insurance provider will not assist.
The amount of assistance varies between different health insurance funds.
The remainder of the gap represents an 'out of pocket' expense to the patient.
Why does a gap exist?
The MBS schedule represents the amount of financial assistance the Commonwealth will provide to patients for private health care, taking into account economic and budgetary constraints. Since the development of the MBS in 1985, the schedule has not increased in line with inflation to reflect the increasing costs of health care provision.
What is the AMA Schedule?
The Australian Medical Association (AMA) issues a regularly updated listing of recommended average fees for the provision of medical services which are calculated taking into consideration the economic burden of providing health care and other circumstances. The fees charged by the surgeons at Melbourne Hip and Knee will always fall within the AMA schedule.
What is an Item Number?
An Item Number is a code which identifies a particular medical service or procedure. Some operations involve more than one component, and therefore have more than one item number. When provided with your admission letter, the item number(s) will be listed. This information is required by your health insurance provider to determine if you are covered for your procedure. The number(s) will also be required by the hospital and other providers of health care services to calculate fees associated with your care.
What are Co-Payments and Gap Cover?
Some health care funds offer 'Gap-Cover' to reduce the out-of-pocket expenses associated with medical services. Benefits payable and conditions associated with gap-cover arrangements are determined by the health insurance providers, and therefore differ between health care funds. Most surgeons do not participate in Gap-Cover arrangements or participate only on a selective basis.