The anaesthesia services provided by your specialist anaesthetist attract a fee separate to those charged by the hospital or other doctors caring for you. You may be able to claim a rebate for a portion of your anaesthetic fees from Medicare and a further portion from your private health insurance fund. Often there is an associated out-of-pocket expense and the size of this ‘gap’ varies greatly depending on your private health insurance fund and your level of coverage. It is your responsibility to pay your anaesthetist fees.
Why is there a ‘gap’?
The fees charged by your anaesthetist is related to the Commonwealth Medical Benefits Schedule (MBS) or the Relative Value Guide (RVG). The MBS reflects the amount the federal government is prepared to reimburse people for medical services and does not reflect the true value of the anaesthesia service. This true value for medical service is provided for by the Australian Medical Association (AMA), with a suggested unit rate of $81.00. All Australian citizens are reimbursed up to 75% of the MBS unit value ($19.80) for anaesthesia services in private hospitals. Health insurance funds usually cover the other 25% but this still leaves a gap. Some private health insurance funds cover part of this gap but the amount varies depending on the health fund. It is also usual for the gap to be larger when the surgery is of longer duration.
Paying your bill
After the surgery, an invoice will be sent to you either by email and/or post. Your anaesthetist will indicate in the invoice the methods of payment accepted.
For patients without private health insurance, payment is required upfront before or on the day of surgery.