Many people who have private surgery are surprised and dismayed when the
bills come in, and after Medicare and their private health insurer have
made their contribution there is still a gap to pay. Medicare will
pay 75% of the Schedule Fee and your private health insurer pays the other
25%. Although private health insurance covers most (but not all)
hospital costs it does not cover the difference between the Medicare rebate
and the doctors fees. Doctors involved in your treatment will
probably include the Surgeon, an Assistant, an Anaesthetist, and pathology
and radiology services.
Before you have private surgery it is important that you find out what
your out-of-pocket costs are going to be. The doctors rooms can
only provide you with an estimate because the actual treatment required
may differ slightly from the proposed treatment. Ask which costs
can be claimed on Medicare and private health insurance and which cannot.
Then you wont be embarrassed when the bills arrive as you will have already
budgeted for the gaps.
It is also important that, before you have private surgery, you are very
sure your private health insurance fund will actually pay for it.
You must always check your eligibility, for example if you have a pre-existing
ailment and have only just taken out private health insurance you may
have to wait for 12 months before the insurer will pay for treatment.
If you have recently changed your level and type of insurance there may
be restrictions that apply, so you also need to check with your insurer
beforehand. Similarly it is wise to confirm what excess payments
you will have to make, for example the policy you have may be one where
you pay the first $200 or $500 of hospital admissions in a given time
period. Dont confuse Extras cover with hospital
cover. Extras insurance covers such things as physiotherapy,
dental, and optical treatment etc but does not cover hospital treatment.
On the other hand, if you do not have Extras cover you will
probably have to pay for physiotherapy out of your own pocket.
Remember that many hospitals ask you to pay up front before
they admit you, so you need to check how much this is likely to be and
be prepared to pay at the time of admission. Some hospitals
also expect you to make a contribution towards your daily room rate so
you need to ask the hospital what this is likely to be.
WorkCover, Third Party and Veterans Affairs
If someone else is expected to pay for your surgery, such as WorkCover,
a Third Party payer, or Veterans Affairs, you must have written
prior approval for the surgery to proceed or else you will have to pay
for it yourself. Having a file number is not enough, as this simply
proves that the claim is being processed but not that it has been approved.
Some people choose to be self insured, that is they have no
private health insurance and are prepared to pay for private treatment,
over and above the Medicare rebate, out of their own pocket. The
doctors fees are likely to be the least expensive, with hospital
and ancillary fees amounting to much more. Hospital fees include
such things as daily bed fees, theatre fees, the cost of surgical aids
and implants, other aids such as crutches and splints, and miscellaneous
charges such as drugs, dressings, etc.
You dont really want to be worrying about all of these things when
you are recuperating from surgery, so
Questions about fees need to be asked before rather than after private
Make sure you ask
the doctors staff for an outline of likely costs and an estimate
of what they might be before you commit your self to undergoing private