Dr Licina’s Fees

If you have private health insurance, most of the costs of your surgery will be covered. However, you will still have to pay a gap for the medical fees.

How much will I be charged for my operation?

The fee you are charged by your surgeon depends on the length and complexity of your surgery. The fee charged is based on the recommendation of the AMA (Australian Medical Association) and will be equal to or less than the AMA fee.

How much will Medicare cover?

The Medicare Benefits Schedule is a list of operations which is compiled and updated by the Commonwealth Government. Each operation is allocated an item number/s and a fee. The fee represents the amount that the government is willing to pay. Medicare will cover 75% of the Schedule fee for in-hospital expenses.

Why is there a gap between the surgeon’s fee and the Medicare rebate?

There are two reasons why there is a gap between the surgeon’s fee and the Medicare rebate:

  • There is a 25% gap between the Schedule fee and the Medicare rebate
  • There is a gap between the Schedule fee and the surgeon’s fee

The Government Schedule was established in 1985. Unfortunately, the Schedule has not increased in line with inflation and the cost of running a practice. This is why most doctors charge more than the Schedule fee, and why the gap between the fee and the Medicare rebate continues to increase. The Schedule also does not necessarily reflect new, more complex procedures and techniques.

How much is ‘the gap’?

The gap depends on the complexity of the operation you are having.

What is GapCover?

GapCover is a scheme offered by health funds which allows your health fund to cover some of the surgeon’s gap, leaving you with a smaller co-payment but restricts the amount the surgeon can charge. It does not take into consideration the complexity of the operation or technology used by the surgeon.

Dr Licina does not participate in this scheme with any health funds.

What does my health insurance cover?

Your health insurance covers the majority of the costs of your operation. Apart from any excess your policy may have, your health fund covers your hospital costs; including bed fees, theatre fees and the cost of implants and prostheses. Please contact your health fund directly if you have any questions. The Privacy Act restricts the information this practice can request on your behalf. Your health fund covers the 25% gap between the Schedule fee and the Medicare rebate.

Will I be informed of the costs?

Our practice provides informed financial consent before your operation. You are informed of the surgeon’s fee, the item numbers used and the out-of-pocket gap. In some cases, the actual procedure performed is different to that quoted for, but your out-of-pocket gap will not change. You will also be given the names and contact numbers for other doctors and providers involved in your operation so that you can contact them for an estimate of their fees.

How will I be billed?

It is the billing policy of this practice that you pay the total cost of surgery at the time of your preoperative visit. The benefit paid by Medicare and your health fund can then be claimed by you after the operation. You will usually receive this refund within a week of submitting the invoice.

What if I don’t have health insurance?

You will receive a Medicare rebate which is 75% of the Schedule fee. You will be responsible for the rest of your costs, including the Schedule gap, the surgeon’s gap, the theatre and bed fee, and the cost of any prostheses, implants and consumables used, as well as fees from other doctors and providers involved. This can add up to many thousands of dollars. We will attempt to provide you with an estimate of these costs. If you cannot afford this, you can seek treatment in a public hospital or take out health insurance and wait the 12-month waiting period before you are eligible for benefits.