Our Fees and The Medicare Gap

Fees for consultations are due on the day of the appointment and can be paid via cash, debit card or credit card. The initial consultation will be the longest and will naturally incur a higher fee. Follow-up and post-operative consultations are generally shorter and therefore billed at a lesser rate.

If surgery is recommended for your condition, the fee charged by Dr Byrne will depend on the procedure being performed and the complexity of the surgery. We are committed to basing our fees on those recommended by the AMA.

All patients will receive a detailed estimate of the costs involved in their surgery. This may also include contact details for other specialists involved in your care, such as anaesthetists, whom you should ask to disclose their separate fees prior to surgery.

If you do not have private health cover, Medicare will cover a portion of your surgical costs. The actual amount is set out in the Medicare Benefits Schedule, a list of operations compiled and updated by the Commonwealth Government. A Medicare rebate is paid toward the operation according to the item number it falls under, with the remaining part of the fee to be paid by the patient. The Medicare rebate you can claim is 75% of the Schedule fee for in hospital expenses such as operations.

Patients need to be aware that the Medicare Benefits Schedule fee will be considerably less that the fee charged by the practice. This is because the Medicare rebate is only intended to cover a portion of the fee and the amounts covered were originally set by the Government in 1985 and have not been adjusted to take into account significant cost increases and inflation. However the AMA issues its own Schedule of Fees based on inflation rates and we use these fees as a guideline for billing.

In addition to the surgical and hospital fees, other out-of-pocket costs are involved which may also include implants and prostheses. We are happy to supply you with a detailed estimate of the expenses involved prior to your treatment.

Patients with private health insurance should find that their fund pays the majority of the surgical costs incurred (depending on your policy’s level of cover). Most privately insured patients also have a hospital excess fee, which they are required to pay. In some cases, there may still be a gap to pay towards the operation. The actual gap amount will depend on the operation you are having, your policy’s level of cover and which health insurance fund you have cover with.

Generally speaking, your health fund will cover your hospital costs, including bed fees, theatre fees and the cost of implants and prostheses. However, as each fund varies it is best to contact your fund for a full estimate of the fees they cover.

Some surgical procedures do require upfront payment prior to the date of surgery. While depending on the type of surgery, others require an upfront fee with the remainder due post-surgery. After surgery you will receive an itemised invoice to be used to make a claim through your private health fund and/or Medicare.

Dr Byrne operates at either the Sunshine Coast University Private Hospital or Buderim Private. Many private health funds have agreements in place with these hospitals to help avoid out-of-pockets costs. Dr Bryne’s patient consultation locations are the Sunshine Coast University Private Hospital and also Noosa Hospital.