Understanding Private Health Insurance

Using your Private Health Insurance

In consultation with your Urologist a surgical procedure may be necessary. Our rooms endeavour to provide you with as much information as possible prior to surgery and a detailed quotation.

In the private system you will have certainty over who will be performing your procedure and can discuss the best hospital location and date that suits you to have the procedure with minimal waiting time.

We have a dedicated specialist Urology Nurse who can be contacted and a Urologist on call at all times.

Costs involved for procedures in the private system generally include:

  1. Surgeon’s fees

    All Urology surgical procedures are covered by Medicare item numbers. These numbers have associated rebates which determine the amount of money paid for the specific procedure by the government through Medicare and Private Health Funds. Unfortunately this amount does not always cover the cost of the surgeon’s time and surgical practice costs to provide the service.

    The difference between costs and the amount paid by Medicare and the Private Health Fund is usually referred to as a “gap” or “out of pocket expense”.

    At North Eastern Urology we quote you on the procedure that the Surgeon has determined is needed and provide you with informed financial consent based on what we expect your health fund to pay. The out of pocket is also quoted. Your quote will include “item numbers” that outline the procedure.

    IT IS IMPERATIVE that you always check with your health fund that your level of cover includes the item numbers.

    During the procedure your Surgeon may be required to perform additional surgery to ensure the best outcome for you. In this case the item numbers may vary slightly.

    Rather than you paying the full amount, then having to claim through Medicare and also your health fund, we will liaise directly with your Private Health Fund and Medicare to cover their portion of the cost. You will only be sent an invoice for the remaining out of pocket cost which is usually as quoted.

    Upfront Payments

    For a select-group of procedures we require the out of pocket costs paid prior to the procedure. A full
    quotation will be provided with surgical information and you will be notified if this is required.

    Uninsured Patients

    If you don’t have Private Health Insurance you can still be seen in the Private Health system. We can
    provide a quotation for you for and you can elect to self-fund.

    Post-op Payments

    Post-op appointments are covered by Medicare with no out of pocket fee.

  2. Anaesthetists’ Fees

    The Anaethetist fee is set by the individual Anaethetist and not dictated by our rooms. We will provide you with your Anaethetists details and contact numbers so that you can contact them.

  3. Hospital bed and theatre costs

    This fee is dependent on your level of Private Health cover, the excess you are required to pay and the arrangement your Private Health Fund has with the hospital.

  4. Pathology/Radiology if relevant

    This fee is dependent on your level of Private Health cover and the arrangement your Private Health Fund has with the hospital.

  5. Implants, prostheses etc. if required

    This fee is dependent on your level of Private Health cover and the arrangement your Private Health Fund has with the hospital.