Billing and Insurance

The insurance and health care industry can be confusing, even for those who work within it. 

 

Our Anaesthetists work as individual practitioners and fees may vary. The anaesthetic fee is separate to charges incurred by other doctors caring for you, and is also separate from the hospital or day surgery facility fees. Unfortunately, in recent years the anaesthetic fee has become higher than the rebate available from Medicare and your health fund. This is because, for the past 25 years, the Commonwealth Government has not adequately indexed the Medicare rebates. In fact there has been a Medicare freeze over the last 6 years with an almost zero increase in the Medicare rebates.

 

At the same time the costs of insurance, compliance administration and running a practise have increased significantly above CPI. The difference between the combined rebate from Medicare and the health fund, and the total fee charged by your Anaesthetist is called the  "funding shortfall " that your insurance does not meet . This is the part of the fee that you will be required to pay yourself, sometimes also referred to as your ‘out-of-pocket expense’. 

 

The rebates that you receive from Medicare and your Health Fund represent approximately 30% of the anaesthetic fee recommended by the Australian Medical Association. The amount that these rebates contribute to your bill will vary depending the rebate policy of your health fund. The Medicare rebates for anaesthesia are amongst the lowest for any medical specialist group, particularly for long cases. The ASA explains the insurance company  funding shortfall in the graph below, as well at this link Why the Gap.

 

For administrative simplicity once your surgery has been booked, our practice policy requires prepayment of any insurance company funding shortfall . 

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