The following notes have been prepared to provide you with some additional information about expenses related to your forthcoming admission to hospital. Hopefully they will answer many of the questions that you may have.
With regard to out of pocket expenses, there are many factors that come into play. For those patients with private health insurance, there are differing levels of insurance funds and arrangements with private hospitals. For those patients covered by a sports insurance policy, these policies vary even more.
You will receive an informed financial consent form regarding out of pocket expenses for the surgeon’s fee when you make your booking for surgery. The surgical fee includes initial follow up visits. However, later consultations (generally those more than three months after surgery) usually attract a separate charge.
It is routine for the surgeon to use an assistant. They will usually introduce themselves to you prior to surgery. Assistants’ fees are calculated at a rate of 20% of the surgeon’s fee.
Naturally, there is also a separate fee for the anaesthetist, for which there may be an out of pocket expense.
Health insurance funds only cover medical fees up to certain levels. Most fees charged will be above these levels so that an out of pocket expense can be anticipated by virtually all patients regardless of their insurance status.
Most sports insurance policies require you to pay your accounts first and then send the receipts to the insurance company for reimbursement. This usually means that you will be required to pay your hospital account on admission.
An estimate of the actual hospital expenses can be obtained prior to surgery by speaking to the accounts department of Epworth Richmond and quoting a Commonwealth Medical Benefits Schedule (CMBS) item number as well as the expected length of admission. Both the anticipated item number and the length of stay can be obtained from your surgeon’s rooms.
However, please note that an estimate of the hospital expenses is just that and only includes the cost of the hospital bed and theatre fee. Other expenses may be incurred (see below) and the final CMBS item numbers may vary depending on the findings at surgery.
Other expenses, which may be incurred, include:
Depending on your health insurance status, you may receive a separate account for physiotherapy.
Many procedures involve having an X-ray taken during or following an operation. In such cases you may receive a separate account for radiology.
Medications which are prescribed for you to take home on discharge will attract a separate fee.
Should you require pathology investigations such as blood tests, you may receive a separate account for these.
Many operations involve the use of implants or fixation devices such as screws, plates or anchors. These are usually covered by private health insurance. However, self-insured patients and those patients covered by sports insurance can expect a separate account for these implants. The cost of these implants is often surprising.
Depending on a number of factors including the type of procedure, your general health and your surgeon’s preferences, a physician may also be involved in your care. In these circumstances you would receive a separate account from the physician.
All surgery carries the risk of complications. Should complications occur, it may require readmission to hospital, which would of course involve additional costs.