Billing & Payment Types
Overview of Payment for Patients
This page explains of practice and payment policies relating to:
- the billing types our practice offers,
- the billing policies for our medical services, and
- further explanations to common fee questions
patients have.
Types of Patients
Our practice treats the following types of private patients:
- Privately Insured Patients,
- Workers Compensation Patients,
- Veteran Affairs Patients, and
- Self Funded Patients.
All Fee Categories
Our practice fees for either Consulting or Surgery may sometimes only be part of your treatment cost.
Other possible fees or disbursements involved in your care are dependant on which course of action is chosen for your treatment. You may need to also check with your health fund to see what is covered for additional areas of service. Potential fee categories to be sure of can include:
- Hospital Fees,
- Surgical Assistant Fees,
- Implants or Prosthesis Costs,
- Anaesthetists Fees,
- Diagnostic Tests (Radiology, Pathology), and
- Post-Operative Care.
Questions to Ask Your Health Fund
When talking with your private health insurance company you should be clear on the following matters:
- Am I covered for the proposed surgical procedure (provide item numbers listed on your estimate of fees)?
- Do I have an excess for my hospital admission?
- Am I covered for other services whilst an inpatient such as, Radiology, Pathology?
About Our Fee Policy
The medical fee rebate system in Australia is complex. A set of fees for medical services is determined by the Federal Government and known as the Medicare Benefits Schedule (MBS). Most procedures involved in your treatment will have a MBS “item number” and the Government sets a Medicare Benefits Schedule (MBS) fee for each item number.
The MBS fee is used to work out how much Medicare will pay. Medicare pays a benefit of 75% of the MBS fee for in-hospital treatment and 85% of the MBS fee for out-of-hospital services. MBS fees are not the fees doctors charge, they are fees set by the government to manage the benefits paid by Medicare.
Surgeons are free to set their own fee for the services, these are also governed by the The Competition and Consumer Act 2010 but are under no obligation to charge fees that are equal to the Medicare Benefits Schedule (MBS) fee or the schedules of medical benefits set by private health insurers.

The same operative procedure can vary enormously in both complexity and operating time between individual patients, and as such there may be significant variations in the operation fee for the same procedure, depending on the individual circumstances. For this reason sometimes it may not be possible for us to provide estimates for operative procedures over the phone prior to a clinical consultation.
Gap for Inpatient Services
You will be provided with an estimate of surgical fees prior to your surgery. This will outline the total fee, the expected rebate from your private health fund/Medicare and the expected 'out of pocket expense'. It will also outline the amount you are required to pay prior to your surgery as a 'surgery deposit'.
The pre-treatment fee estimate includes the specific item numbers to be used and enables you to discuss with your health insurance company what you are covered for and if benefits are applicable.
Depending on your surgical procedure and both the complexity and operating time between individual patients, there may be significant variations in the operation fee for the same procedure, depending on the individual circumstances.
Some surgical procedures will require you to pay a 'know gap' which is where you pay the difference between the health fund amount and the doctor's fee. Your private health fund and Medicare pay the rest. This usually limits your out-of-pocket surgical costs to a maximum of $500.
Other surgical procedures may be charged at a private rate (set by the doctor) or AMA (Australian Medical Association recommended fee schedule). In this case, you will be required to pay the full fee and then make a claim from your private health fund and Medicare following the procedure.
Self Funded Patients
Patients without private health insurance can choose private admission. These ‘self-funded’ patients assume all costs of the admission including the:
- Gap between the Medicare benefit and specialist's fees,
- Hospital Fees,
- Surgical Assistant Fees,
- Implants or Prosthesis Costs,
- Anaesthetists Fees,
- Diagnostic Tests (Radiology, Pathology), and
- Post-Operative Care.
