We understand that Health Insurance and surgical fees can be complex and confusing.
Please read the following and feel free to contact our staff if you have any questions. 

What is the Medicare Benefits Schedule "MBS" ?

Medicare is the Australian Commonwealth program provides access to health care for Australian Citizens. The Medicare Benefits Schedule (MBS) is the list of services and the dollar amounts that are subsided by the Australian Government through Medicare. 

Private Health Funds use the Medicare Benefits Schedule "MBS" as a base rate to calculate the private fund rebates. 

The Australian Medical Association "AMA" prepare a list of medical services and fees for private patients, and index this each year to cover increasing costs such as medical Indemnity, staff wages and inflation. 

It is important to note that all health funds pay rebates according to their own schedules calculated using the base rate of the Medicare Benefits Schedule "MBS" 

 

 

How are Dr Gill's Fees Calculated ? 

Dr Gill's elective surgery fees are approximately 65% of the AMA fee and are in line with most Health Funds Gapcover rebate amount. 

Will I have to pay for my surgery ? 

If you are a private patient in John Hunter Hospital you will be provided with a Quote for Trauma Procedure. If you are scheduled for an Elective Surgical Procedure in a Private Hospital the following will apply. Please contact us on 49694033 if you are not certain of what your fund will cover.

  • If you are a member of the funds listed below under the "Gapcover" list and you have the appropriate level of cover, you will not be required to pay up front for your surgery. 


  • If your fund is listed under the "Known Gap' list, and you have the appropriate level of cover, then you will have an  "Out of Pocket" expense of $500


  • If your fund is not listed here, you will be required to pay the full amount prior to surgery and submit your account to your health fund for a refund. 

 

 

GAP COVER - No account issued to patient

  • ACA Health Benefits Fund
  • Australian Unity Health Ltd *some policies excluded
  • CBHS Corporate Health Pty Ltd
  • CBHS Health Fund Ltd
  • CUA Health Ltd
  • Defence Health
  • Emergency Services Health Pty Ltd
  • GMF Health
  • GMHBA Limited
  • HBF Health Limited
  • HCF
  • Health Care Insurance Ltd
  • Health.com.au
  • Health Partners
  • Health Insurance Fund of Aust.Ltd
  • myOwn
  • Navy Health
  • Nurses and Midwives Health Pty Ltd
  • Onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Ltd
  • Queensland Country Health Fund Ltd
  • Reserve Bank Health
  • Rt Health Fund
  • Teachers Health Fund
  • The Doctors’ Health Fund
  • Transport Health
  • TUH
  • UniHealth Insurance
  • Westfund

ALL OF THE ABOVE HEALTH INSURANCE COMPANIES ARE NOT FOR PROFIT ORGANISATIONS, SO YOUR HEALTH INSURANCE DOLLARS GO TO YOUR HEALTH CARE AND NOT TO SHAREHOLDERS

KNOWN GAP - $500 Out of Pocket

  • BUPA
  • Medibank Private and subbrands (AHM, Kogan)


THE ABOVE HEALTH INSURERS ARE PRIVATE HEALTH INSURANCE COMPANIES, SO YOUR HEALTH INSURANCE DOLLARS ARE GENERATING PROFITS FOR THE COMPANIES AND THEIR SHAREHOLDERS


NO KNOWN GAP, POOR REBATES - more than $500 Out of Pocket, will need formal quote

  • NIB and subbrands (including APIA, GU Health, Qantas Health)

*there are significant out of pocket costs for NIB and subbrands, as NIB chooses to rebate significantly less than most other health insurers and does not have a known gap arrangements


THE ABOVE HEALTH INSURERS ARE PRIVATE HEALTH INSURANCE COMPANIES, SO YOUR HEALTH INSURANCE DOLLARS ARE GENERATING PROFITS FOR THE COMPANIES AND THEIR SHAREHOLDERS


 

AHSA FUNDS with no access gap cover arrangement, more than $500 Out of Pocket, will need formal quote

  • Budget Direct Health Insurance
  • Frank Health Insurance


THESE FUNDS ARE NOT FOR PROFIT BUT OFFER LOWER REBATES FOR PEOPLE WHO PREFER LOWER PREMIUMS BUT EXPECT TO PAY MORE WHEN CLAIMING

Can't find your fund ? 


If your fund is not listed here then you will be provided with a "Quote for surgical procedure" and will be required to pay the full account and claim your refund via your fund.

Unfortunately, this may result in a larger "out of pocket" expense as accounts not forwarded directly to the fund will only be rebated the MBS fee (75% from Medicare and 25% from your fund) 

Please read Important Health Fund Information below



© COPYRIGHT 2017 Dr David Gill