An Important Notice for Australian Unity Customers

As of 21 Apr 2016 Australian Unity have introduced 4 basic levels of cover that only offer cover to the level of the schedule fee.  Please see below for details.
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 Anaesthesia billing is complex.  It is based on both the type of procedure you are having and the time that the procedure takes.  There can also be additional charges for ancillary procedures such as advanced monitoring techniques, some pain control techniques, for patients who have serious medical conditions, and for the very young or the elderly.  All these factors contribute a set number of "units" to your final account.

For any procedure there is a given number of units associated with a procedure of that type.  In addition the time taken is charged in units of 15 minutes for the first two hours, between two and four hours each unit is 10 minutes long and after 4 hours a unit is 5 minutes.  Your account will show these amounts separately,  one amount for the procedure itself, one for the time component, a charge for your preoperative anaesthetic consultation, and separate, itemised charges for any additional items.

The number of units is then totalled and this is used to calculate the final account.

For out of hours emergencies there is a further 50% loading to the total account.

We currently charge $50 per unit for most procedures.  The current recommended amount per unit suggested  by both the Australian Society of Anaesthetists and the Australian Medical Association is $83 per unit.  We review our charges annually,  however the Government has delayed any indexation medical fees.  In addition, anaesthesia fees have not been indexed now for several years. Unfortunately this is not sustainable for us, and our fees have risen slightly.  We have reviewed our fees for the 2017-18 financial year and have decided to leave them at the current rate of $50 per unit.

We will send your account directly to your health fund and to Medicare electronically.  For many funds there will be a gap between our charge and the amount of your health fund and Medicare rebate.  We will invoice you for this gap.  Please note that this gap varies from fund to fund, in our experience large gaps are almost always due to extremely long procedures, or when patients are with those funds that provide low rebates for anaesthesia services.  We list the item numbers charged on your gap invoice, however these will show a charge of $0, and only the gap amount will appear on the invoice.  As we have already claimed from Medicare and your health fund, you will be unable to claim any of the gap.  We are also happy to discuss your account with you at any time, either by phone or in person at our rooms.

We endeavour to provide every patient with a written estimate of what the total cost as well as any out of pocket expenses will be in advance of your procedure.  To that end we ask that you return the anaesthesia booking form to us as soon as possible.  These forms are available from your proceduralist, or from our website.  Please note that the actual amount may vary from that shown on the quote.  This usually occurs when the procedure takes a significantly longer (or shorter) amount of time from that used in generating your quote.   Occasionally your surgeon will perform a different procedure or procedures to that originally planned due to unexpected findings at the time of operation.  This can also sometimes change the amount of your account.

For aesthetic surgery procedures we charge the full recommended ASA/AMA fee of $83 per unit.

For overseas patients who are not covered by Medicare or private health insurance we charge the full recommended ASA/AMA fee of $83 per unit.  Many such patients may find this fee is covered by any Travel Insurance they may have.

For out of hours emergency cases we cap any gap to $500, even where your fund does not have a cap on any gap payment. 

For uninsured patients, overseas patients, and patients having aesthetic surgery procedures we will invoice you prior to the procedure, this amount is based on the procedure itself and the estimated time your procedure will take.  We ask that you pay this in full prior to your procedure.  We will either invoice you after the procedure for any additional amount or provide you with any refund owing.

We understand that sometimes it can be difficult to manage unexpected bills.  Please feel free to talk to us about how we can help, in such circumstances we are happy to arrange a payment schedule that will best suit your needs.

 

KNOWN HEALTH FUND ISSUES:  Mildura District Health Fund, Latrobe Health Services, Australian Unity, GU Health, and Medibank Private.


Larger Gaps

Some patients are surprised at the size of their gap.  In our experience very large gaps in relation to the complexity and time taken for your procedure occur most often with a small number of health funds.  The main fund that is the biggest source of patients concerned at the size of their gaps is  Latrobe Health Services.    This fund pays a very low rebate for anaesthesia services, which results in gaps that can often amount to many hundreds, or even over a $1,000. We must point out that this fund has performed particularly poorly over a number of years in the AMA Health Insurance Report Card.  The report is available here.  Your gap payment to your surgeon, to the hospital, and to us is quite likely to wipe out any cost saving in lower premium. We have to ask: is it worth supporting a local fund that may in the long run cost you significantly more?  Mildura District Health Fund are the other fund we find often generates very large gap payments, however they have recently increased their rebates, although not to the level of the major funds.

 

Australian Unity are a member of AHSA and generally patients with Australian Unity do not experience large gaps.  However as of 21 Apr 2016 Australian Unity introduced new policies, or altered existing policies affecting four of their products:

  • Care N'Repair
  • Smart Start
  • Budget Hospital
  • Basic Hospital

 

These policies will cover you up to the schedule fee only.  This means you will only get back a very small rebate over the 75% of the schedule fee that you will receive from Medicare on your anaesthesia bill in percentage terms.  Taking removal of a simple skin cancer from the face as an example:

Under the full featured Australian Unity product your anaesthesia bill is likely to be around 13 units or  $650.  Medicare will reimburse $148.50.  The health insurer will reimburse a further amount up to a total of $460.20, leaving a gap of $189.80

Under the new Australian Unity products your anaesthesia bill will still be around $650.  Medicare will still reimburse $148.50.  The fund will only make this up to $257.40, resulting in a gap of $392.60.  This is an increase in the gap payment of $202.80, or a gap of nearly $400 on a $650 bill.   Your fund will have contributed just over $100 of this amount.

You are likely to have similar increases in gap with both your surgeon and the hospital.  We suggest you ask yourself the following questions before taking out one of these products: 

  • How much is your premium?  Is this value for money?
  • Would you rather pay a gap of $189.80 or $392.60? 
  • Is a gap of around $400 for a relatively minor procedure offset by any saving on premium?
  • Is any saving in your premium completely wiped out by your increased gap payments with your anaesthetist, surgeon, and private hospital? 

 

GU Health Unlike other funds we regularly deal with GU Health do not participate in ECLIPSE, the online claiming system.  This means we are unable to submit your account directly to Medicare and the health fund and invoice you only for any gap payment.  If you are insured with GU Health you will receive an account for the full amount and you will be required to pay this in full and then claim any rebates back from Medicare and the fund.  This is unfortunately beyond our control.

 

Medbank Private still have a number of customers who are on older products that only provide for private treatment in a public hospital.  If you are on these products you are not eligible for Gap Cover.  Unfortunately we have no way of easily determining if a patient is on this older product and it often only comes to light once the fund has paid us at the schedule fee rate only.  We will have already invoiced you for your gap, but under these circumstances we will contact you to arrange payment of the difference between the schedule fee and the known gap amount paid by Medibank.  If you are on one of these products we suggest you contact Medibank and see if you can arrange a better level of cover.

 

GMHBA As of 1 April 2016 GMHBA  became a full participating member in the Australian Health Service Alliance Access Gap Cover Scheme, which bought their fees into line with other AHSA funds.  GMHBA had previously been a fund that often generated large gaps, however this is now no longer the case.  Although GMHBA has performed poorly in the AMA Health Insurance Report Card in the past, we expect this will no longer be the case.  Please note that as two other GMHBA products, Frank and Budget Direct Health Insurance will not be participating in Access Gap Cover, patients with these funds may still be subject to very large gaps.

In addition, do not be fooled by advertising campaigns claiming you may save on increased taxes.  The increased Medicare levy only cuts in of your taxable income exceeds $180,000 a year for families (including couples), or $90,000 a year for singles.  If your income does not reach this level you will not have to pay the Medicare levy surcharge if you do not have private health insurance.

The AMA publish annually a Health Insurance report card detailing the amounts paid by a number of funds for a range of procedures.  It demonstrates there is a very wide variation in what funds will pay for the same procedure, a variation of as much as 158%  Anaesthesia services are not included in this report, but in our experience those funds that pay a low rebate for the services listed in the report card are also the funds that usually pay a low rebate for anaesthesia services.  The report is available here.

We can not recommend any particular health fund over any other.  The decision on what fund to choose is a matter entirely for you to make.  We hope the information above helps you make this decision. 

DISCLAIMER:  Dr Harding and his family are covered by one of the full featured AHSA funds.