This section aims to provide you with some basic financial information about the health system. There is universal health cover in Australia from Medicare. This means that all Australian residents are covered by the public health system.
The private health system offers the advantage of choosing your surgeon (Dr Balakumar) and access to a better choice of elective surgery. The disadvantage is the financial costs associated with the surgery. Most doctors’ costs are paid for by Medicare and health insurance companies supplement a little to this. In fact most of your health insurance goes into paying for your hospital stay and not the doctor’s costs. There are several costs when seeing a specialist surgeon:
1. Initial Consult fee - $200 for Dr Balakumar
2. Subsequent Consult - $100 for Dr Balakumar
3. Cost of Surgery – AMA fee schedule.
There are several costs to surgery. Most patients believe the bills they are paying are for the surgeons. In reality there are multiple providers who are sending out bills to the patients and the health insurance company:
Most orthopaedic consultations and procedures are covered by Medicare item numbers.
All orthopaedic surgeries are covered by Medicare item numbers. These numbers have an associated rebate. The government determines these rebates and the private health insurance companies supplement these rebates by up to 25%.
Unfortunately, these rebates have not changed much since 1983 and have not kept up with inflation, let alone the costs of running a quality practice and the increasing cost of indemnity insurance. The difference between the costs and the rebates has given rise to the GAP. Most surgeons will charge AMA (Australian Medical Association) rates for the services. This is almost three times the Medicare rebate and reflects the true discrepancy.
Uninsured patients will require a quote from the hospital and the prosthesis companies. Once again the surgeon’s fees are mainly rebated by Medicare and therefore the patient will not have to pay much out of pocket for their surgeon.
[Last Updated May 2014]
64 Chapman Street
North Melbourne VIC 3051
Ph: (03) 9329 5525
Fax: (03) 9329 4969
Melbourne Orthopaedic Group
33 The Avenue
Windsor VIC 3181
Ph: (03) 9573 9659
Fax: (03) 9521 2037
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© 2012-2014 Jit Balakumar - Paediatric & Adult Orthopaedic Surgeon, Melbourne
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