Practice Billing
Fee Structure
Initial Consultation
Dr Macgroarty sees all new patients in either his rooms or the sessional suites from where he consults. The price of these office consultations are available upon request from our friendly staff.
Follow-up Consultation
If you are being followed-up in the office by Dr Macgroarty and his team for the first time after surgery, a consultation fee is usually not charged.
Other follow-up appointment costs will be outlined by our friendly staff prior to your appointment with Dr Macgroarty.
Dr Macgroarty’s Operation Fees
The fee depends on the type of operation you will be having done. Please note that Dr Macgroarty’s fees are independent of Medicare item numbers and are not calculated with these in mind. MBS Item numbers which Medicare use relate to the amounts for which your health funds will reimburse. This amount is separate to Dr Macgroarty’s fees. You will be given a full quote by Dr Macgroarty’s staff prior to surgery. If the fees are unclear or further explanation is required, please call our friendly staff.
The Assistant
The assistant is an essential part of any operation. Their fees are usually about 20% of the surgeons fee (however may be higher or lower) and may attract a partial rebate from Medicare. Dr Macgroarty has no control over the assistant billing practices. Brisbane Knee and Shoulder clinic recommends you obtain a direct quote from the assistant prior to surgery. Our friendly staff will be able to provide the details of the assistant being used for your surgery.
Please note that Assistant fees are made in accordance with the instructions from the individual Assistant and are not under the control of Dr Macgroarty.
The Anaesthetist
The anaesthetist’s fees depends on a number of factors. Brisbane Knee and Shoulder Clinic recommends obtaining a separate quote from Dr Macgroarty’s Anaesthetist prior to surgery. The specific Anesthetist being used for your operation will be outlined by Dr Macgroarty’s staff in advance of your operation.
Please note that Anaesthetist fees are made in accordance with the instructions from the individual Anaesthetist and are not under the control of Dr Macgroarty.
The Hospital
This is charged according to the number of days you are in hospital. It is calculated from midnight to midnight. A private hospital bed costs in the vicinity of $500-600 per day, depending on the hospital and the type of room. These costs may be covered if you are in “top cover” private health.
Brisbane Knee and Shoulder Clinic recommends that patient’s contact their private health insurer for all information about any out of pocket expenses or excesses that relate to their upcoming surgery.
The Operating Theatre
The cost of this varies according to the complexity of your operation and how long it takes. These costs will be covered if you are in “top cover” private health.
Prostheses and implants
In orthopaedics, many operations require the use of prostheses and implants, such as shoulder and knee replacements, plates and screws, and anchors.
Other costs
These may include medications, blood tests, x-rays and physiotherapy. Your doctor may ask another specialist to see you, especially if there are complications or health concerns. If you need to go to Intensive Care, there will be extra costs.
Can I get a quote?
Dr Macgroarty’s staff will provide you with an estimate of the proposed fee. In most cases it will be accurate but it may vary if something different or extra needs to be done at the time of surgery. The anaesthetist can also give you an estimate if you contact them and give them the item number or numbers most likely to be used during surgery.
What out-of-Pocket expenses should I expect?
If I have private insurance
There will be a gap between the fees that the surgeon, assistant and anaesthetist charge and the Medicare rebate. Some of this difference is covered by your private health insurance. Your insurance may cover the hospital bed, theatre fees, prostheses and implants, and may also cover some or all of the other costs.
Brisbane Knee and Shoulder Clinic recommends that patient’s contact their private health insurer for all information about any out of pocket expenses or excesses that relate to their upcoming surgery.
If I do not have private insurance
Medicare will pay some of the fees that the surgeon, assistant and anaesthetist charge but there will be a gap to pay. You will have to pay the full cost of the hospital bed, theatre fee, prostheses and implants, and other costs.
How will I be charged and how should I pay?
The bills will come from different sources at different times:
- Surgeon fee
This invoice will be issued prior to the operation. To secure your place on the operating list, you will need to pay this fee in full no less than five (5) days prior to surgery. - Assistant and Anaesthetist’s fee
This invoice will be issued by the above individuals soon after the operation. - Hospital fee
If you have an excess on your private health insurance policy, you will be required to pay this on admission. If you do not have private health insurance, you will be required to pay part or all of the anticipated hospital costs on admission. The remainder will have to be paid when you are discharged. Brisbane Knee and Shoulder Clinic recommends you speak directly to the hospital to determine payment methods relating to hospital costs.
General Information
What is the Medicare Benefits Schedule?
The Medicare Benefits Schedule (MBS) is a listing of how much financial assistance the government will provide to assist patients with the costs associated with health care provided by a private specialist.
What is a ‘gap’?
A gap is the difference between what the doctor charges and the Medicare rebate. For operations your health insurance provider will pay a portion of the gap. For clinic appointments your health insurance provider will not assist. The amount of assistance varies between different health insurance funds. The remainder of the gap represents an ‘out of pocket’ expense to the patient.
Why does a gap exist?
The MBS schedule represents the amount of financial assistance the Commonwealth Government will provide to patients for private health care, taking into account economic and budgetary constraints. Since the development of the MBS in 1985, the schedule has not increased in line with inflation to reflect the increasing costs of health care provision and this has resulted in “gap” costs.
What is the AMA Schedule?
The Australian Medical Association (AMA) issues a regularly updated listing of recommended average fees for medical services which are calculated taking into consideration the economic burden of providing health care as well as other circumstances.
What is an Item Number?
An Item Number is a code which identifies a particular medical service or procedure. For example, ACL reconstruction is identified by the item number ‘49542’. Some operations involve more than one part, and therefore are associated with more than one item number. When provided with a quote for your operation, the item number(s) will be listed. This information is required by your health insurance provider to calculate the benefit you will receive from the government and your private insurer for this service. The number(s) will also be required by the hospital and other providers of health care services to calculate fees associated with your care.
As stated above, Dr Macgroarty’s operation fees are set independent of the item numbers required by medicare / health funds for each operation.
You are strongly advised to check with your helath insurance provider if you have “exclusions” on your cover. Lower cost insurance premiums often have fine print exclusions.
What are Co-Payments and Gap Cover?
Some health care funds offer ‘Gap-Cover’ or ‘Co-Payment’ arrangements to reduce the out-of-pocket expenses associated with medical services. Benefits payable and conditions associated with gap-cover arrangements are determined by the health insurance providers, and therefore differ between health care funds. Most surgeons do not participate in Gap-Cover arrangements or participate only on a selective basis.
NB Please note that a Medicare refund for any health service delivery is only available if the patient is eligible for Medicare benefits and the service is provided according to a valid referral.
