PRIVATE HEALTH INSURANCE AND SURGERY
Should you require surgery, our staff will always provide a detailed quote of surgical fees and any out of pocket costs not covered by your insurance. Please check with your insurer to ensure you are covered for the procedure.
Invoicing for surgery can be confusing and complex. There are many Insurers in Australia and they all have different criteria and rules for reimbursement. Basic/bronze policies do not cover all procedures.
Listed below are simplified explanations of the 3 main ways we invoice. Which one is used will depend on your insurer (some insurers do not insure to Industry standards/accepted fee schedules), your level of cover and the particular procedure being performed;
Direct billing to the patient prior to surgery. The patient then claims from their Insurer.
Known Gap, prior to surgery the patient is charged a ‘known gap” this is an ‘out of pocket’, non-refundable cost set by the Insurer. Our staff then send the surgery invoice directly to the insurer.
No-Gap, all billing is done by our staff directly to your Insurer. There is no out of pocket cost.
Our Surgeons operate at various Private and Public Hospitals as well as Victoria Parade
Surgery Centre (VPSC) for Day procedures. The surgeon will select the most appropriate facility for your procedure taking into account your insurance, health requirements and age. Some private surgery can be performed at Public Hospitals. Also, some basic Insurance only covers for surgery in a public hospital. The Hospital will contact you prior to surgery to ensure all fees and ‘out of pocket’ expenses are understood. For example, if you have an excess with your policy.
Your Anaesthetist will also provide a quote for the anaesthetic which will depend on the type and length of the surgical procedure.
Other fees may be incurred if pathology, radiology, or pharmacy is required
WHAT TO EXPECT AFTER SURGERY
Following surgery, you will be provided with instructions for appropriate post-operative care. The initial post-operative review will be booked prior to surgery.