This page outlines Dr Gandy’s explanation for patient’s payment options depending on their circumstances. The page covers the following explanations and payment options:
- Explanation of Fees
- Private Patients
- Public vs Private
- Payment Policy
- Tax Refund Scheme
- No Private Health Insurance
The initial consultation will incur a fee. Generally, our doctors are no gap for privately insured patients.
A quotation of this fee will be given at the time of your booking. This fee is payable at time of appointment and a receipt given for claiming back your Medicare rebate.
An Explanation of Fees
The standard fees charged by our rooms are in line with the Australian Medical Association recommended fee schedule. This means that in most instances there will be a ‘gap’ between our surgical fee and what is covered by Medicare and your health insurance fund.
If there is any problem with this, it is important that you ask about this gap. Our staff are fully informed with charges and rebates and will be able to help you navigate through what can be a complex process. These fee explanations can cover:
- Consulting Fee
- Surgical Fee
- Treatment Estimates
If you require more information, please do not hesitate to call the practice during office hours.
Other Possible Disbursements
There may be other charges involved in your care depending on which course of action you choose. You need to also check with your health fund to see what is covered for additional areas of service. Potential areas of cover are:
- Surgical Assistants
- Implants or Prosthesis
- Tests (Radiology, Pathology)
- Postoperative Care
We offer informed financial consent to all our patients prior to surgery. This is a pre-treatment estimate of your surgical costs. This estimate enables you to discuss with your health insurance company what you are covered for and if benefits are applicable.
If you have private health insurance that covers the types of procedures we perform, then your health fund excess is payable of the day of the procedure.
If you choose to be treated as a private patient, you will be treated at hospitals that our doctor is affiliated to or is a visiting medical specialist. After discharge, your care will be carried out in either an outpatient clinic or in my private rooms, or will be referred to your local general practitioner.
Types of Private Patients
This practice caters for a range of Private patients, these include:
- Private Health Insured
- Department of Veterans Affairs (DVA)
- Work Cover
- Self-Insured (Uninsured)
- Overseas Patients
Private Health Insurance
Private Health Insurance allows you and your family to access the right health services at the right time. You have control of your health care and can choose the provider, facility and timing of your treatment. With the security and protection of private health insurance, you have access to an extensive range of private hospitals and can rest assured that your health is in good hands.
Depending on your level of cover, some health funds also require you to pay an excess. We are not responsible for these costs but our staff will do their utmost to guide you to better understanding.
Our practice accepts most private health insurance programs. Our staff can also help with your claim for benefits, but we remind you that your specific policy is an agreement between you and your insurance company.
Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated.
Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with the AMA fee schedule.
You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.
Department of Veterans Affairs (DVA)
The Australian Government’s Department of Veterans’ Affairs (DVA) provides support to current and former serving members and their families through a range of benefits (including ongoing or one off payments). for further understanding on how you can apply these benefits to our service and the scope of cover please refer to: http://www.dva.gov.au/benefits-and-payments
Arrangements between Dr. Gandy and the state government insurance regulator covers patients involved in workplace and motor vehicle accidents.
These state specific arrangements are designed to ensure that workers have priority access to surgeons.
Access Gap Cover
All privately insured patients undergoing surgery the public hospital will be treated under a 'No Gap" arrangement, meaning zero out of pocket expenses.
Depending on the procedure required and your level of health cover, you may be eligible have your surgery performed, at a private hospital, under the 'Known Gap*' or ‘Sometimes No gap*' scheme of your private health fund depending on your level of cover.
A few insurance companies participate in a "known gap" scheme*. Under this agreement the health fund agrees to pay a higher proportion of your costs and your surgeon limits the gap fee to a low level set by the insurance company.
*Note that: No (or known) gap schemes are in respect to your surgical fees they may not cover other hospital related expenses, such as blood tests, scans and other doctors’ fees.
If you are self-funded (no private health insurance), the full hospital fee is payable on admission.
Patients may be able to choose private admission even if they do not have private health insurance. Self-funded patients will be liable to pay the following:
- The gap between the Medicare benefit and any specialist’s charge
- The gap for diagnostic services (medical imaging and laboratory), however some of these services may be bulk billed to Medicare, that is no ‘gap’
- Hospital accommodation fees (bed charge)
- Surgically implanted prostheses
- Dental Services
Essentially this means you must meet all costs of the admission yourself except those covered by Medicare.
For further information about being a private patient, contact our rooms
Overseas Patients with Non-Reciprocal Agreement
If you are an overseas visitor, you will be required to pay the full hospital fee on admission.
If you are an overseas patient from a country where there is no Reciprocal Health Care Agreement, you are not eligible for Medicare and you are responsible for payment of all fees and services.
Non-Medicare patients are billed for inpatient and outpatient services regardless if they choose public or private admission.
Reciprocal Health Care Agreement - If you are a visitor from a country where Australia does have a Reciprocal Health Care Agreement (RHCA), you may be eligible for treatment that is deemed immediately necessary for any health problem or injury whilst in Australia. RHCA does not cover pre-arranged or elective treatment. Overseas patients who are covered by the RHCA will not be covered if they choose private admission.
Please contact usfor more information.
Private vs Public Fees
You may choose to be a public or a private patient. This page provides patients with the different options are for surgery in the private or public hospital system.
Public Hospital Patients:
Australian residents who decide to be a public patient are entitled to free treatment under Medicare. Your treatment will be carried out by an appropriate specialist which will be arranged prior to your admission. After discharge, your care will either be continued in an outpatient clinic or you will be referred to your local general practitioner.
In the public hospital, the surgery is sometimes performed by a registrar (specialist in training) but the registrar is supervised by a senior surgeon who is responsible for your care.
There are no fees for surgery in the public hospital, however, there is a waiting list. Your position on the waiting list will be based on the severity of your condition. Your follow up visits after surgery will be arranged through the hospital or your specialist’s rooms
Private Hospital Treatment:
In the private system, I will perform your surgery personally and will also look after you if you are advised to be an in-patient. All follow up appointments will be in my office.
Our reception staff will be happy to advise you of the consultation fee upon booking an appointment over the telephone. Fees for consultation along with other necessary forms will also be emailed to you for your convenience upon booking an appointment.
- Surgical fees are billed directly to the Health Insurance Providers.
- Where out of pocket co-payment are required which can vary depending on the type and complexity of surgery or procedure. Patients will be advised, in writing, after the consultation, the amount of gap payment.
- Fees for uninsured patients are advised by the accounts manager and hospital upon request.
Payment on the day of consultation is much appreciated.
How to Pay?
For your convenience, we accept several payment methods in the rooms, by post and online:
- Cheque and Cash
- Credit Card: VISA, MasterCard, Amex (logos),
- Electronic other - (Credit Card, EFTPOS, BPay)
No Private Health Insurance
I admit patients to the Prince of Wales Public Hospital, where I have regular operating lists. The care in the public hospital is excellent and free of charge to you. Public hospital waiting list is administered by the public hospital and the length of wait may vary according to the severity of your condition and the time of year.
Several people choose to "Self-Insure" or pay for their own surgery, so they don't have to wait. This could be a worthwhile investment as it means you can have your operation done straight away or whenever it suits you. This can allow you to get back to your work and sport as soon as possible.
The costs may not be as high as you think, but could prove prohibitive for complex procedures that require an extended stay in hospital. I would not recommend having complex procedures performed in a private hospital, as a self-funded patient, unless cost is no issue. Some less invasive surgeries like endoscopy, colonoscopy, hernia repair or gallbladder removal, usually performed as day surgery or an overnight stay, may be more manageable in terms of cost.
If you choose to be a self-funded patient, all the private hospital fees associated with your surgery are an out-of-pocket expense, but we will assist you in obtaining an estimate of costs from the private hospital before you go ahead with your surgical procedure.
Call my practice and they will be happy to provide you with costings. A proportion of my fees and the anaesthetic fees attract a rebate from Medicare.
If you require more information, please do not hesitate to call us on during office hours.