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 Fund Gapcover rebates.
Will I have to pay for my surgery ?
If you elect to utilise your health fund cover as private patient in the John Hunter Hospital you will not have an out of pocket expense from Dr Gill. If you are scheduled for an Elective Surgical Procedure in a Private Hospital the following will apply.Please note that these arrangements are accurate at the time of publishing however are subject to change.
Please contact us on 49694033 if you have an queries regarding Out of Pocket costs for surgery.
- 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 up to $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.
Dr Gill does not participate in any scheme whereby doctors are paid financial incentives from health insurance companies to influence treatment recommendations such as post operative rehabilitation
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
- Frank Health Insurance
- GMF Health
- GMHBA Limited
- HBF Health Limited
- 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
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)
- HCF
THE ABOVE HEALTH INSURERS HAVE A REDUCED DOCTORS' REBATE SCHEDULE AND “KNOWN GAP’ ARRANGEMENTS TO KEEP PREMIUMS LOWER.
THIS MEANS YOU MAY PAY LESS FOR YOUR COVER HOWEVER EXPECT TO INCUR ADDITIONAL COSTS WHEN YOU CLAIM.
PRIVATE “FOR PROFIT” FUNDS OFTEN USE THIS MODEL
NO KNOWN GAP, POOR REBATES - more than $500 Out of Pocket
- NIB and subbrands (including APIA, GU Health, Qantas Health)
You will be provided with quote for surgery as Informed Financial Consent. 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 arrangement.
THE ABOVE HEALTH INSURERS ARE PRIVATE "FOR PROFIT" HEALTH INSURANCE COMPANIES.
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
- Budget Direct Health Insurance etc
You will be provided with a quote for surgery as Informed Financial Consent
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