Before you go into hospital for any proposed treatment as a private patient, it’s your right to ask your doctor about his or her fees and to find out about the fees of other doctors who might be involved in your care. You should also ask your health fund about what you are covered for and whether you will have any out-of-pocket costs to pay.
Unlike other services, anaesthetists (as with other professional medical specialists) do not have a standard scale of fees. The fee charged by your anaesthetist is related to the Medical Benefits Schedule (MBS) number or the Relative Value Guide (RVG) number.
You should be aware of the cost of your anaesthesia before your private medical procedure. You should also be aware that Medicare and health fund rebates may not cover the entire cost of your anaesthesia. This difference between the anaesthetist’s fee and your rebates is the ‘gap’. The size of the ‘gap’ varies greatly depending on your health fund.
Wherever possible you should contact your anaesthetist to obtain an estimate of the anaesthesia fees, including Medicare item numbers, prior to your procedure. This information will allow you to enquire from your health fund about the level of benefits available to you.
Your safety and satisfaction are the prime concerns. However, for private patients, the Government and other parties require that financial issues be addressed and that patients receive an estimate of their anaesthesia fees, where practical.
There will be a separate fee from your anaesthetist for the anaesthesia services provided to you. You should be aware that Medicare and health fund rebates may not cover the entire cost of your anaesthesia. This difference between what is covered and the actual fee for the anaesthesia services is known as the ‘gap’ and will be your personal responsibility to pay.
Whether there will be a gap and the size of the gap varies greatly depending on your health fund. It is also usual for the gap to be larger when the surgery is of long duration.
Wherever possible your anaesthetist will provide you with an estimate of your anaesthesia fees prior to your procedure, as well as providing you with other useful information such as Medicare item numbers. This will allow you to enquire further from your health fund about the level of benefits available for your procedure. However if you haven’t been given an estimate of your costs or have any enquiries relating to anaesthesia fees you should contact your anaesthetist before your procedure.
Medicare will rebate a portion of the unit value and if you have private health insurance, your health fund will rebate a further portion.
Each health fund has its own rebate arrangement so it is imperative that you contact your fund to obtain your anaesthetist’s fee estimate. The ASA has created an information sheet with more detailed information on fees, rebates and indexation. You can contact the ASA Policy team email@example.com with any additional questions.
If you do, it may be helpful to write them down for discussion with your anaesthetist.
For more information on doctors’ fees and private health insurance, telephone the Private Health Insurance Ombudsman Hotline 1300 362 072, email them at firstname.lastname@example.org, or check out their website.