What is the difference between the Public and private systems?

In the public hospital the surgery is performed by a registrar (doctor training in urological surgery). A consultant surgeon will be responsible for your care (not necessarily me). There are no fees for surgery in the public hospital as this is funded by the government. However, there is a waiting list. You position on the waiting list will be based on the severity of your condition. Your follow up visits after surgery will be in my office where you initially saw with me. Catheter or stent removal will be done in the public hospital outpatient clinic.

In the private hospital system, I will perform your surgery personally and will see you after surgery. I will be directly responsible for all aspects of your care. All follow up appointments will be in my office. You are also able to select a date and hospital. If you have insurance it will usually cover the hospital costs and part of the medical costs. Without insurance you will be responsible for all costs.

With insurance there is usually a gap payment. Sometimes this is called a “known gap” where a part payment is collected from the patient and the remainder is send directly to the health fund. In other settings you will be responsible for the entire invoice – you then submit a claim to the fund.

“Known gaps” are usually collected 2 days before surgery. In the other setting the procedure is billed for the day after it is performed, and you will be issued with a tax invoice immediately. This can then be submitted to the health fund for reimbursement.

You will be informed of all out of pocket surgical costs prior to the surgery. There may be other charges from the anaesthetist, the hospital, radiology and pathology. We achieve 100% informed financial consent.

Why is there a gap?

Gaps exist as the fees paid by Medicare and the insurance companies have not kept even close to with inflation. The current reimbursements would have been acceptable about 20 years ago! Private insurance premiums have risen every year without fail, however the fees they pay out have certainly not.

Depending on your level of cover, some health funds also require you to pay an excess. I am not responsible for these costs and you need to check with your insurer. The hospital at which your procedure will be done always checks your level of coverage as well. If you want to know if your insurance covers you please ask my staff for the item numbers and then call your insurer.

If you have issues with your insurance company, you can contact the health insurance ombudsman.

All patients in my practice have full informed financial consent. You will be informed of all possible additional fees. You will need to contact my anaesthetists to obtain their fees.

If you have any questions or concerns please contact my office. Listed below are two documents from the Australian Medical Association which outline the AMA’s policy of fees.