The medical fee rebate system in Australia is complicated. Outlined here is a guide to fees and rebates to assist your understanding and your claim procedures.
A fee that is fair and reasonable, based on the complexity of the surgical procedure and the expertise and experience required for its performance, is charged by this practice.
A fee is charged for your initial, and any subsequent, consultations. Part of this fee will be subsidised by Medicare.
Separate fees for additional procedures, performed during the consultation, may apply.
Please contact us for any questions you may have about the fees for your consultation.
The surgical fee covers the cost of the operation and your normal post-operative care including visits in hospital or consulting rooms for one month.
Each operation is specific to the patient. During a surgical consultation, your surgeon will evaluate your condition and discuss any recommended operation, and associated surgical fee, with you. Unfortunately, we are not able to provide you with fees for your operation prior to this evaluation. Operation fees will usually be higher than the MBS fee.
At the time of booking an operation we charge a booking fee. This fee does not attract a Medicare rebate, but may be used for tax refund purposes.
After the operation, you will be invoiced the surgical fee for the surgeon (and in some cases the assistant). This invoice can be used for Medicare and private health fund rebates.
A surgical assistant ( another doctor) is usually required during the operation; their fee is usually 20% of the surgeon’s fee. In some cases the assistant’s fee is included in your account and in other cases the surgical assistant will bill you directly. If the assistant’s fee is included in your account this payment will be passed on to the assistant.
Fees for a surgical operation will typically be charged by
- The hospital charges for accommodation and theatre fees.
- Medicare makes no contribution to private hospital fees.
- Your private health insurer contributes to the private hospital fees.
- Please contact your private health fund for details of your entitlement.
- The surgeon and the assistant at operation (surgical fee).
- The anaesthetist.
- Radiologist (for X-Rays etc.)
- Pathologist (for laboratory and blood tests).
The Medicare Benefits Schedule (MBS) fee
A fee determined by government and published as the Medicare Benefits Schedule.
The MBS fees and our fees were originally similar. However, over many years increases in the MBS fees have been restricted to much less than the rises in the CPI and Average Weekly Earnings index and very much less than the costs of running a specialist medical practice (see graph).
The fee we charge takes into account the progressively increasing costs of providing high quality surgical services
Medicare and Health Insurance Subsidy
When privately insured, your health insurer should pay 25% of the MBS fee for services provided in hospital. Although insurance premiums have increased over the last few years, nearly all the payments from the funds have gone to private hospitals, not towards doctors’ fees.
Medicare pays 75% and the private health fund pays 25% of the MBS fee for in-hospital medical services. There will be a co-payment for which you are personally responsible.
Accounts and Receipts
Before the operation, you will pay a booking fee for your operations. We will give you a receipt for this payment. This receipt does not attract a Medicare rebate.
After the operation, we will provide you with an invoice showing the outstanding amount you need to pay. This invoice can be used for Medicare and private health fund rebates. We request payment of your account balance within 30 days.