- What will my anaesthetic cost?
- How do I claim from my health fund?
- Why doesn't my health insurance cover my full anaesthetic fee?
- Where can I get more information?
- Can I switch my health insurance? When should I do it?
Q. What will my anaesthetic cost?
We will send you anaesthetic information via text message or email as soon as we are notified of your procedure by your surgeon's rooms. This will include information about your anaesthetist and your anaesthetic fee.
Pacific Anaesthesia's anaesthetists are committed to a sustainable private health care system and set their fees accordingly. The anaesthetic fee varies for each procedure, and is separate from the surgeon's and hospital's fees. This fee is calculated based on a number of factors including the length and nature of the procedure and anaesthetic as well as your general health.
Some anaesthetic fees will be fully covered by your fund, while others will require you to pay a 'gap'. A 'gap' is the portion of the anaesthetic fee that is not covered by Medicare and your health fund.
Q. How do I claim from my health fund?
Pacific Anaesthesia aims to make the financial side of your anaesthetic as easy as possible!
With the exception of NIB and self-funded patients, we will claim all rebates on your behalf, meaning you will only need to pay the gap, rather than the full anaesthetic fee.
If you are with NIB, you will need to pay the full anaesthetic fee. Once this is paid, we will submit a claim on your behalf and you should receive your rebates via electronic transfer or cheque.
Self-funding patients are required to pay the full anaesthetic fee prior to their procedure. Very uncommonly, the pre-paid fee may not cover the final anaesthetic fee. We will get in touch with you if this is the case. Once your account is finalised, we will submit a claim to Medicare for you, and you should receive your rebates via electronic transfer or cheque.
If you do not receive your rebate or our claim is rejected, we will happily provide you with a receipt so that you can discuss it with your insurer and Medicare.
Q. Why doesn't my health insurance cover my full anaesthetic fee?
A gap exists because Medicare and health fund rebates over time have not risen in line with the costs of providing anaesthesia services.
Health funds have different rebates for surgical and anaesthesia fees and unfortunately this is not well advertised. Some health funds have programs to limit the amount of gap you have to pay to a reasonable amount. Some funds have poor rebates with no programs to limit any gap as well as imposing onerous conditions on doctors.
The following diagram demonstrates each component of your anaesthetic fee:
Q. Where can I get more information?
The following resources provide further information about anaesthetic fees:
The Australian Society of Anaesthetists has an excellent guide to how your private health insurance works:
The AMA produces an annual "report card". Page 8 of the 2018 guide provides a good comparison of health fund rebates (dark green is best, dark red is worst). It is important to note that these are the maximum rebates, and may reduce to the "MBS Fee" (left column) if the gap exceeds the "known gap" (bottom row).
Q. Can I switch my health insurance? When should I do it?
You can switch your private health insurance at any time and it is easy to do. Call your new fund and they will make all the arrangements for you, including contacting your old fund – it’s that simple! Your old fund will pay back any money you’ve paid in advance.
Generally you won’t have to serve any waiting periods if you keep the same level of cover, but you should check with your new fund when you sign up.