Anaesthesia Associates fully supports the initiatives of the Commonwealth Government, the Australian Medical Association (AMA) and the Australian Society of Anaesthetists (ASA) for obtaining Informed Financial Consent. The anaesthetist’s in our practice are committed to providing patients with as much information regarding the fees for their anaesthetic and likely out of pocket expenses as is possible.
Fees and rebates for anaesthesia are very dependent on time taken for a procedure, and also vary with other factors such as age, physical status, emergency status and whether the procedure occurs in normal working hours or after hours or on weekends.
Therefore it is no longer possible to predict exact amounts of fees or “out of pocket “ expenses for your anaesthetic.
“Out of pocket” or “gap” expenses occur because Government legislated rebates from Medicare and Private Health Funds have failed to increase in line with medical practice costs (especially compulsory Medical Indemnity Insurance, staff salaries and inflation) since the very beginning of Medicare. Nor have they kept up with increases in Average Weekly Earnings or the Consumer Price Index.
The fees for your anaesthetic, irrespective of the particular anaesthetist caring for you, will almost certainly be higher than the rebates available from Medicare and your health fund. As a result in most cases there will be an “out of pocket” expense for which you will be personally responsible. This expense or “gap” also depends on the nature and duration of the surgery performed, as well as varying between health funds.
The Australian Medical Association (AMA) and Australian Society of Anaesthetists (ASA) prepare a list of medical services and fees for private patient anaesthesia services, and index this each year. These fees are carefully calculated using the AMA’s Medical Fees Index to reflect the actual dollar value of the service provided.
Most anaesthetists base their fees on this. The Commonwealth Government also publishes a Medical Benefits Schedule of Fees on which is based the rebates you are allowed to receive from Medicare and your health fund. These “fees” are determined unilaterally by government, within the constraints of its budget, as the maximum benefit it allows you to receive. They are not properly indexed, and are not arbitrated or agreed fees as they would have you believe. Unfortunately rebates for anaesthesia services are well below the true value of the service.
Many private health funds accept that fees for anaesthesia will be higher than the Commonwealth Schedule Fee and pay you a higher rebate to reduce your “gap” if you have been provided with an “Estimate” for your anaesthetic account. This is a “Known Gap” arrangement.
Unfortunately, some large funds like BUPA, HCF and NIB do not do so, resulting in members of these funds having larger “gaps” to pay. To obtain the higher rebate from a participating “Known Gap” health fund, your claim must be made DIRECTLY to your private health fund, which will claim your Medicare rebate on your behalf. Our staff will contact the health fund to arrange this. When you receive your account if you are covered by a “Known Gap” fund, the bill will be for the “gap” amount only and your fund will have taken care of the rest.
Alternatively, for those in health funds that do not participate in “known Gap” arrangements (and to benefit from the discount often offered by your anaesthetist for early payment), you may pay the account in full to your anaesthetist directly and forward the receipt to your private fund to make your claim.
The anaesthetists at Anaesthesia Associates charge a range of fees and it is important that you contact our staff to gain an estimate of fees for your forthcoming anaesthetic.
Phone our office on (02) 8887 0700 or email admin@norwestgroup.com.au or click here to contact us.
If you have concerns about your ability to pay the estimated fee for your anaesthetic you should discuss the matter with your anaesthetist prior to your procedure.
