Gaps, Rebates, Fees

We Will Contact You With Fees After Your Surgeon Gives Us The Details

1-2 weeks before your scheduled surgery, the surgeon's rooms send us the theatre list with the exact surgeries and patient names. After this has happened, we will reach out to you via both SMS and email with the gap estimate.

The surgeons will not send out an updated patient theatre list immediately after seeing you in clinic. If it is less than 1 week from the surgery, please email our rooms if you haven't heard from us.

Anaesthetist Role

Your Anaesthetist is a medical specialist who, after obtaining a medical degree and working for initial years as a doctor, has then entered an additional minimum 5 years of specialised, supervised and scrupulously examined training under the framework of ANZCA, focussed specifically on the science and art of anaesthesia.

We work alongside your Surgeon / Proceduralist. We establish the conditions necessary for your surgeon to operate on you, while actively steering and supplementing your body’s own survival processes to keep you safe under those surgical conditions.

Anaesthetic fees are concordant with the expertise and responsibility described above. We work alongside the Surgeon with an entirely separate role: sustaining your life and keeping you safe during your surgery.

The fees are separate from the Surgeon’s fees and the hospital fees.

"Gap" or "Out-Of-Pocket" Fees

Summary:

The "gap" is the difference between our anaesthetic fee, and what Medicare & your private health insurer (PHI) pay us on your behalf when we bill them.

Please note: Medicare & your PHI will not rebate or refund your anaesthetic gap fee. It is an "out-of-pocket" expense covered by you. After the procedure is done, the only anaesthetic related money left to be resolved, is by us, to your PHI & Medicare. We will bill them ourselves.

Background:

The "gap-fee" payment, is the main way that Care Anaesthetics bills privately insured patients.
Medicare & PHI's each pay a set amount towards your anaesthetic fee. Those amounts were fixed many years ago and have since, not kept pace with the real cost of providing specialist care, so in most cases today they only cover part of the fee. The difference between what they pay us and the entire anaesthetic fee we bill is the "gap", sometimes called the "out-of-pocket" amount.

Before your surgery you will be quoted the gap-fee amount, so there are no surprises. This is called informed financial consent. If anything about the plan changes on the day, such as a longer or more complex procedure, under our care, the gap fee will not change.

If you are being quoted in the gap-fee-structure, the gap fees will generally not be over $500.

Upfront Collected Full-Fee

In some cases the full fee is collected before your surgery. This applies when you have no private health insurance, when your fund does not cover the procedure, or when an item is not covered by Medicare, for example many procedures with a cosmetic component.

You will receive an itemised receipt after your anaesthetic. Where a Medicare or health fund rebate does apply, you can lodge that receipt and the rebate is paid directly to you.

Children & Elderly

Children & elderly patients often need extra time, preparation and monitoring, before, during and after the anaesthetic. A small child may need a parent present at induction and a slower, gentler approach; an older patient may have several severe medical conditions and medications that need careful planning around.

Despite this, we generally extend a no-gap or discounted fees for patients under 18 and over 75 years of age.

"Known-Gap / No Gap"

Many health funds run known-gap or no-gap schemes. Under a no-gap arrangement the fund pays the whole fee and you pay nothing. Under a known-gap arrangement you pay a fixed, capped amount that is agreed in advance, and the fund pays the rest, typically at a higher remuneration. Care Anaesthetics does not have these arrangements in place, however your gap payment will not be higher in most circumstances.

Please check with your fund that your policy covers the procedure and that any waiting periods have passed. A fund that does not cover the surgery will not cover the anaesthetic either.

For gastroscopy / colonoscopy procedures, we do not charge a gap. We will collect our fee directly from your PHI & Medicare.