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Insurance and Fees - Professor Marcus Atlas

Informed Financial Consent

As a service to our patients, we provide informed financial consent (an estimate) of our surgeon’s fee that will be required to pay for in-hospital or day surgery elective procedures.

The estimate will not cover services provided by other doctors, or other costs associated with admission to hospital (i.e. accommodation, pathology, radiology, pharmacy or physiotherapy).

We encourage patients to discuss these costs with their health fund to ensure their membership covers admission and procedure, and if required, to contact our staff to fully understand the out-of-pocket costs.

Out of Pocket Surgical Costs

Before any treatment, we will present you with all the possible options and estimate for out-of-pocket costs. We will work with you to find a way for treatment to be carried out with the highest level of care possible.

Out-of-pocket costs include surgery, prostheses and hearing devices. Reimbursement depends on your health fund and your level of cover. Medical prostheses and devices are fully covered by your health fund. Further information can be found at the Australian Government’s Private Health website or the Department of Health’s Private Health information.

In most cases, a gap fee will be applied on top of the benefit received from Medicare and your Health Fund. This gap fee is shown on your estimate and is payable at your first post-operative appointment.

Why Do Surgeries Charge Their Own Fees?

The Australian Medical Association (AMA) provide a comprehensive summary:

“The fee charge by a medical practitioner covers not only their own personal income, but also his or her practice costs – the wages for practice staff (nurses, receptionists, administrators), and other costs for running a medical practice such as equipment, medical supplies, cleaning, rent, electricity, computers, continuing professional development, accreditation and insurance.

Since Medicare began 40 years ago, Government indexation of Medicare Schedule Fees have not kept pace with real increases in practice costs. This is why today patients will find there is a difference between the amounts of the fee their doctor charges and their Medicare rebate. These are commonly called ‘out-of-pocket costs’, because the patient must make up the difference out of their own pocket.

The AMA encourages medical practitioners to charge a fair and reasonable fee having regard to their practice costs and the particular individual circumstances of their patients.

Medicare rebates are not payable for any medical service that is not listed on the MBS, or when the service is not considered to be ‘clinically relevant’, that is the service is not generally accepted in the medical profession as being necessary for the appropriate treatment of the patient.  In both cases, the payment arrangements are a private matter between the treating medical practitioner and the patient.”

What is the Difference Between Admission as a Private or Public Patient?

Our surgeons perform surgery for patients who are self-funded and those with private health insurance. If you choose to have your surgery as a private patient, you are able to choose your surgeon and an admission date at your convenience.

For patients with private insurance, your chosen surgeon will perform the operation. For patients with Medicare cover and who elect to have their surgery in the public hospital system as a public patient, your preferred surgeon may not perform the operation, but may supervise surgeons-in-training during surgery. As a public patient you are unable to choose your treating doctor or your surgery date.

Self-Funded Patients

If you have no health insurance, you can still elect to be a private patient and cover all costs yourself.

In this case, costs will include:

  • Surgical fee
    An estimate can be provided on request. Medicare may refund some of this fee.
  • Anaesthetist fee
    An estimate can be provided by the anaesthetist on request. Medicare refunds some of this fee.
  • Hospital fee
    A quote is provided by the hospital to include accommodation charges, theatre fees, fees for hospital doctors and a ‘miscellaneous’ fee to cover unexpected costs. Fees are required to be paid on admission. Medicare does not refund any of these fees.

If you are considering admission as a self-funded patient, please contact our office for more information.

Interstate Patients

Interstate patients are welcome to make an appointment to see Professor Atlas. Please obtain a referral letter from your General Practitioner or Specialist if you wish to claim a Medicare benefit and send all your information to our office via post, fax, email or via our online referral form.

Overseas Patients

Overseas patients and those without Medicare coverage are able to have consultations, investigations and surgery in Australia. Please contact the office if you wish to arrange an appointment. A referral is not required. However, please attach all relevant information, such as a hearing and balance assessment and radiology reports, or use our online referral form.