Billing & Insurance

The insurance and health care industry can be very confusing, even for those who work within it. Our anaesthetists work as individual practitioners and fees may vary. The anaesthetic fee is separate to charges incurred by other doctors caring for you and is also separate from the hospital or day surgery facility fees.

The insurance and health care industry can be very confusing, even for those who work within it.

Our anaesthetists work as individual practitioners and fees may vary. The anaesthetic fee is separate to charges incurred by other doctors caring for you and is also separate from the hospital or day surgery facility fees. Unfortunately, in recent years the anaesthetic fee has become higher than the rebate available from Medicare and your health fund. This is because, for the past 25 years, the Commonwealth Government has not adequately indexed the Medicare rebates. In fact, there was a Medicare freeze for many years with an almost zero increase in the Medicare rebates.

At the same time, the costs of insurance, compliance administration, and running a practise, have increased significantly above CPI. The difference between the combined rebate from Medicare and the health fund, and the total fee charged by your anaesthetist, is called the “funding shortfall" that your insurance does not meet. This is the part of the fee that you will be required to pay yourself, sometimes also referred to as your ‘out-of-pocket expense’. The graph below gives an indication of the disparity between CPI and increased costs (in light blue) vs. Medicare indexing (in dark blue).

Billing & Insurance

Medicare & Health Fund Rebates

The rebates that you receive from Medicare and your Health Fund represent approximately 30-40% of the anaesthetic fee in the Australian Medical Association Schedule. Health funds vary quite significantly in what they pay, and some pay even less than this.

Some prominent health insurance companies unfortunately have a policy of further reducing their benefit should a doctor not be “contracted in“ and agree to be paid the fees stipulated by the insurance company (which are typically 60-70% less than the AMA schedule). This is known as ‘benefit reduction.’ Questions as to why certain insurance companies do this should be directed to your health fund. Our rooms will unfortunately not be able to explain why this is done. Insurance company contact details can be found here.

Medicare rebates for anaesthesia are amongst the lowest for any medical specialist group, particularly for long cases. The ASA explains the insurance company funding shortfall in the graph below. More information can be found from the ASA here and on our FAQ page.

For administrative simplicity, once your surgery has been booked, our practice policy requires prepayment of any insurance company funding shortfall. For some insurance companies they may require the entire amount to be paid upfront and you can then claim the insurance rebate afterwards.

Billing & Insurance

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