Each health fund has a different product offering and this can affect the total out-of-pocket fee.
- Funds such as Medibank Private, BUPA, Australian Unity, HCF, and most AHSA Funds offer what is called a known gap product. Our anaesthetists are able to claim most of their fee directly through the Fund and Medicare (utilising the fund’s Access Gap Cover system). The patient is then sent a separate out of pocket payment. This is your known gap.
Generally these funds will have the lowest out-of-pocket fees.
- Funds such as NIB do not have a known gap product and do not allow us to send a separate out of pocket account. Therefore, the patient receives the account in full. This will result in a higher out-of-pocket fee compared to the funds listed above, as any rebates due to the patient will only be paid at the Schedule Fee.
- Funds such as Latrobe Health, Frank Insurance and Mildura District Hospital Fund all pay significantly lower rebates than other funds, and it is likely these will be associated with the highest out-of-pocket fee.
It is always recommended that you phone your health fund to ensure you are covered for your procedure and that no exclusions apply.
Our rooms will always try to ensure maximum benefits for the patients utilising the Access Gap Cover scheme where possible.
Should you require further clarification about anaesthetic fees, please refer to the information sheet as prepared by the Australian Society of Anaesthetists (ASA):