ANAESTHESIA FEES EXPLAINED
If you receive treatment in hospital as a private patient, you may be charged separately by the hospital and each doctor involved in your surgical care. As such, you may be charged a separate fee by Dr Ratnavadivel as your Anaesthetist for his specialist services.
As Dr Ratnavadivel is an independent medical practitioner, his fees may vary from the fees of other Anaesthetists. Dr Ratnavadivel’s fees relate to the Medical Benefit Schedule (MBS) number and the Relative Value Guide (RVG) number, and are based on guidance from the Australian Society of Anaesthetists (ASA) and the Australian Medical Association (AMA).
Your Anaesthetic Fees are determined by several factors:
- Type of procedure
- Complexity of the anaesthesia
- Length of procedure and whether it takes place during or after normal working hours
- Age and general health
- Health insurance cover
As part of Informed Financial Consent (IFC), you will be given an estimate of anaesthesia fees before your procedure, where practical.
You will receive a copy of Dr Ratnavadivel’s IFC for the provision of Specialist Anaesthesia Services from your surgeon’s room.
You will also be sent anaesthetic information, including Medicare item numbers, via text message as soon as Dr Ratnavadivel is notified of your procedure by your surgeon’s rooms or your admitting hospital.
This information will allow you to enquire whether your anaesthetic fees are being reimbursed partly or fully by your health insurance provider or Medicare.
You should contact your health insurance provider to discuss the rebates available.
As the IFC is based on the average time for the procedure, it is an ESTIMATE ONLY.
Your rebates from Medicare and your health insurance provider may be lower than your anaesthesia fees and may not cover the cost of your anaesthesia. Any part of the fees not covered is known as the out-of-pocket or ‘gap’ and is your personal responsibility to pay.
The minimum rebate you will receive is the Medicare Benefit Schedule (MBS) Fee. If you have private health insurance, your health fund may rebate a further portion, also called ‘Known Gap’ Cover, to further reduce your gap payments.
Out-of-pocket ‘gap’ payments exist, because Medicare rebates for anaesthesia services are low and do not adequately reflect the level of responsibility and the complexity of training required for anaesthetists.
Medicare and health insurance rebates have not risen over time in line with the cost of providing anaesthesia services.
As each health fund has its own rebate arrangements, your gap and the size of your gap varies greatly depending on the rebate rate offered by your health insurance provider.
It is important that you check your cover with your health insurance provider and ask how much they will pay.
Known Gap Cover
Some private health insurance providers offer a ‘Known Gap’ Cover, an amount in excess of the Medicare Benefit Schedule (MBS) Fee.
If you are insured with any of the Australian Health Service Alliance (ASHA) Funds, Medibank Private, AHM, HCF or BUPA, your health fund may pay the MBS and health insurance rebates directly to Dr Ratnavadivel. You may only have to pay the ‘gap’ and may not have to make a claim to your insurer.
As part of the Known Gap arrangements, Medicare and private health fund rebates cover 60-70% of your anaesthesia fees.
Most health insurance providers have set a maximum allowable Known Gap of $500 in order for individual medical providers to claim rebates directly from your health fund. However, for long and complex procedures the ‘gap’ payments would generally be much higher than $500. In these instances, the full anaesthesia fees are your personal responsibility to pay and your total rebate would depend on your insurer.
No Gap Cover
Some private health insurance providers, such as NIB and NRMA do not provide a Known Gap Cover. These health funds have a No Gap Only policy, which means their rebates will be much lower. Patients insured with those health insurance providers will have a significant higher gap to pay despite the anaesthesia fees being the same.
Members of these health funds will have to pay their anaesthesia fees in full first before they can claim the rebates from their health fund. Rebates from these health insurance providers will cover around 30-40% of the anaesthesia fees.