Surgery Cost in Australia
Patient Connector has put together this article to help make sense of surgeon’s fees in Australia. Patient Connector makes it easy to help choose a specialist doctor based on a number of factors.
What are the costs for a consultation
The fee for an initial consultation with a specialist surgeon in Australia generally varies between $200 and $300. If you have a GP referral and have a Medicare card, you will be eligible for a Medicare rebate, which is $73.85 for an initial consultation. You will be asked to pay the full fee for the consultation and sometimes the surgeon’s Practice Manager / receptionist can then claim the Medicare rebate on your behalf. If this is the case, the rebate of $73.85 will usually be in your nominated bank account in 48 hours. In some instances, you will need to make the Medicare rebate claim yourself. You will still incur an out of pocket or “gap” fee between $126.15 and $226.15 on average. Note that private health insurers do not cover any fees associated with consulting with a specialist doctor.
Why is there an out of pocket cost?
Most fees are more than the Medicare rebate and the underlying reason for this is because since the introduction of Medicare in 1976 the rebates have not increased in line with indexation. On average Medicare rebates increase by 1.7% each year, while Average Weekly Earnings (AWE) and the Consumer Price Index (CPI) increase by 3%. That means that while the cost of running a practice increase, the rebate the Government provides to specialists does not increase at the same rate.
What other fees are there when having surgery?
When you decide to have surgery, it is important to understand that the surgeon is just one of the fees associated with having that surgery. You may also need to pay fees for the following services:
- Anaesthetist: if you require a general anaesthetic, you may have to pay an out of pocket cost to the anaesthetist. The anaesthetist and surgeon are separate businesses and generally the surgeon will not know the anaesthetist’s fee. You will have to discuss this directly with the anaesthetist. You may be eligible for a Medicare rebate and if you have private health insurance, your fund may also cover some of this fee. You will need to call your private health insurer to confirm this
- Surgical assistant: your surgeon may require assistance during your surgical procedure. If this is required, you will need to pay a fee to the surgical assistant for their services. They will contact you directly.
- Hospital fee: you will need to decide with your surgeon which hospital you would like your procedure to be undertaken. Note that surgeons are registered to operate at specific hospitals and cannot operate at all hospitals. Once you decide which hospital to conduct your procedure, you will need to contact the hospital to find out the fee. The fee will vary depending on whether you have to stay overnight and the number of nights you spend there to recover. If you have a Medicare card, you are generally entitled to a Medicare rebate for some of this fee and if you have private health insurance, you may also have a private health insurance rebate. You will need to contact your private health insurer to find out if your level of insurance cover includes hospital stays.
- Medical imaging, pathology tests etc: either before or after surgery, your surgeon may ask you to have some tests conducted, either to help them diagnose or determine the extent of your injury or condition and also to follow up post operative and observe your recovery and the result of the procedure. There may also be additional costs associated with these tests.
What is the AMA fees list?
The Australia Medical Association publishes a list of services and fees annually for its members. This list is the fee for the service recommended by the Australian Medical Association and unlike the Medicare Benefits Schedule (MBS), is indexed to the Consumer Price Index. Generally the AMA recommended fee is higher than the MBS rebate. The AMA recommended fee is only a guide and each specialist doctor independently determines their fee.
What else beyond the fees for surgery do I need consider when choosing a specialist?
Like any aspect of making a purchase, there is a range of factors that influence a patient’s decision as to which specialist they see. Some patients are eager to see a specialist sooner as they are in pain or are anxious to have answers or commence treatment. These types of patients may choose a specialist with a shorter waitlist. Other patients may prioritise seeing a specialist doctor close to their home or work, or even close to a friend or family member who is driving them to and from hospital and visiting each day. For these patients, location is very important. Above all else,the experience and qualifications of each specialist is highly relevant. This includes their areas of advanced training, the years of experience and their areas of expertise.
How can Patient Connector help?
We help find the balance between fees, availability, location convenience and the required experience and training for each procedure.