When you have a procedure through Sydney Fibroid Clinic as a private patient in a private hospital, the cost is usually shared between:
- Medicare
- your private health insurer
- you, the patient
Medicare and private health insurance may not cover the entire cost. Any amount you need to pay yourself is called an out-of-pocket cost or gap.
Specialist consultations before and after your procedure
Appointments with your Sydney Fibroid Clinic specialist before or after your hospital admission are generally considered out-of-hospital services.
Medicare usually provides a rebate equal to 85% of the government’s Medicare Benefits Schedule fee. However, the Schedule fee is not necessarily the same as the consultation fee charged by the specialist.
If the consultation fee is higher than the Medicare rebate, you will need to pay the difference. Private hospital insurance generally does not cover specialist consultations provided outside hospital.
Your procedure in a private hospital
When you are formally admitted to a private hospital for your procedure, Medicare generally pays 75% of the Medicare Schedule fee for eligible medical services.
Your private health insurer usually pays at least the remaining 25% of the Schedule fee, provided that:
- your policy covers the procedure
- you have served any applicable waiting period
- your membership is current
- the treatment is not excluded or restricted under your policy
The Medicare Schedule fee is a government-set amount and may be lower than the fee charged by your specialist. Any difference that is not covered by Medicare or your insurer becomes your medical gap.
Your insurer may contribute more if the specialist can use the insurer’s no-gap or known-gap arrangement. This depends on the particular insurer, policy and procedure.
Sedation at Sydney Fibroid Clinic
Sydney Fibroid Clinic procedures are performed under intravenous sedation administered as part of your procedural care.
A separate anaesthetist is not required, and Sydney Fibroid Clinic does not engage a surgical assistant. Therefore, you will not receive separate accounts from an anaesthetist or surgical assistant for your procedure.
The private hospital account
The hospital’s charges are separate from the specialist’s professional fee. The hospital account may include:
- day-stay or overnight accommodation
- use of the procedure room or angiography suite
- nursing care
- medicines, and other consumable items
- medical devices or implants used during the procedure
- meals and other hospital services, when applicable
Medicare does not pay private hospital facility charges. Your private health insurer contributes hospital fees according to your level of hospital cover and its agreement with the hospital.
You may still need to pay:
- your hospital policy excess
- charges for excluded or restricted treatments
- costs for medicines, devices or items not fully covered
- additional charges if the hospital does not have an agreement with your insurer
Having private health insurance does not necessarily mean that every cost will be covered.
Other possible fees
Although there is no separate anaesthetist or surgical-assistant account, you may occasionally receive separate accounts for services such as:
- pathology or blood tests
- medical imaging
- pharmacy medicines
- another specialist consultation, if medically required
The hospital or Sydney Fibroid Clinic will advise you if any additional providers are expected to be involved.
What to check before your procedure
Before confirming your treatment, Sydney Fibroid Clinic will provide information about our specialist’s fees and the relevant Medicare item numbers.
We can you to check or you can contact your private health insurer and ask:
- Is this procedure’s key item number covered by my policy?
- Have I completed waiting periods?
- What excess or co-payment will I need to pay?
The hospital can provide separate information about its charges and any excess or co-payment payable on admission.
Informed financial consent
We aim to explain our fees before your procedure so that you can make an informed decision.
Your individual costs depend on the procedure, the hospital, your health-insurance policy and the benefits paid by Medicare and your insurer. Any quotation is therefore an estimate based on the information available at the time.
