Specialist anaesthesia services are separate from those provided by your surgeon and the hospital. My fee is based on the length and complexity of the anaesthesia, and may not be fully covered by health fund rebates, so a gap (out-of-pocket amount) may apply. This is because health fund rebates have not risen in line with the cost of providing anaesthesia services.
Your actual bill may differ from the estimate — for example, if the procedure takes longer or less time than expected. Some funds also pay a lower rebate than others, which means a higher out-of-pocket cost.
Patients with private health insurance: Most major funds now run a “gap cover” or “known gap” scheme. Where I participate in your fund’s scheme for your procedure, your out-of-pocket cost is capped — for most schemes this is a maximum of $500 per doctor for the hospital admission. For most short procedures (under about 45 minutes) the gap is usually well below this, but the exact figure depends on the length of the procedure and what your particular fund pays. The main schemes are:
- AHSA Access Gap Cover — a single scheme used by 25+ funds, including Australian Unity, GMHBA, Latrobe Health Services, HBF, Defence Health, Teachers Health, Doctors’ Health Fund, Police Health, Frank and CBHS.
- Medibank / ahm — GapCover.
- nib — MediGap / GapSure.
- Bupa (which now includes the former HBA, MBF and Mutual Community) — Bupa Medical Gap Scheme.
- HCF (which now includes the former Manchester Unity and rt Health) — Medicover.
Where your fund allows direct billing, I will send the claimable portion of the account straight to your fund and the balance (the gap) to you. For funds without a direct-billing arrangement for my account, the full account will be sent to you; you then claim your rebate back from your fund and Medicare.
Important: a known-gap cap only applies if my fee for your procedure fits within the scheme. For a longer or more complex case where my fee is above the cap, the claim reverts to the fund’s standard scheduled-fee rebate, the rebate is lower, and your out-of-pocket cost will be higher. I will provide a written estimate (informed financial consent) before your procedure wherever possible.
Patients with no private health insurance are responsible for a larger gap, and may be required to pay the account before the procedure. You will receive a receipt to claim your Medicare rebate.
Patients with no Medicare cover are responsible for ensuring the account is paid in full by an agreed method before the procedure.