Perth Haematology :: Dr Steven Ward
Medicare & Health Fund Information
This practice aims to
provide excellent specialist medical care. In order to
provide this service an appropriate fee must be charged
to cover running costs. The cost of providing medical
care (including overheads, secretarial support, office
space, stationery, and so on) continues to increase with
inflation. However the Medicare rebate has not changed
significantly for a few years. In fact Medicare will
only pay up to 85% of the fee it sets. It is not indexed
to inflation or average weekly earnings. It is set by
the government, as an amount that the government is willing
to pay to help subsidise medical care for
Australians. It does not reflect the actual cost or
value of the service. Indeed the AMA has published
a list of fees, which have increased in line with
inflation, and are held to be fair remuneration for the
service provided. These fees are substantially higher
than the Medicare rebate. I do not intend to charge fees
at AMA levels, but the fees will be higher than the
Medicare rebate, so a “gap” payment will be required
from the patient. The table below indicates the
approximate fees, and the Medicare rebate for outpatient
consultations. Note the Medicare rebate has been frozen
Note: Fees for in-patient services will be different. Private Health Funds will pay towards the costs. These services are indicated by an * after the item number on the account. For most private health funds the account for in-patient services is sent directly to the fund for payment, and generally no patient payment is required (Gap Cover).
Most specialists, and many GPs, cannot sustain their quality services by accepting the government fee alone. We are happy to discuss the fees charged at any time. This letter explains the reasoning behind the “gap”.
Finally payment of accounts is required on the day of the consultation. EFTPOS and credit card facilities are available. Administrative costs incurred in recovering excessively overdue payments will be passed on, and added to the account. Discounted fees will also revert to full AMA rates.
Medicare is the Federal government organisation that administers rebates for eligible medical services.
Medicare rebates are set by government. All Australians have a Medicare Number and Card.
Medical accounts from GPs, Specialists, private Hospital admissions, Pathology and Radiology can be presented to Medicare for payment of a rebate. The rebate will pay towards the cost of the service.
The eligible services are Medical Services provided by private GPs and Specialists as well as private in-patient hospital admissions.
PRIVATE HEALTH FUND
Health Funds are allowed by legislation to cover in-patient hospital admissions (including day-case procedures) and not out-patient Medical services.
Health Funds pay the difference between the Medicare rebate and the Schedule Fee (or a higher amount if the doctor participates in Simplified Billing and Gap Cover arrangements with the health Fund.
Health Funds will also pay towards drugs, physiotherapy, pathology and radiology for private in-patients.
STATE GOVERNMENT PUBLIC HOSPITALS
The State Governments are responsible for providing, and funding, State Public Hospitals. Public patients in these hospitals are not eligible for Federal Medicare rebates, nor Health Fund payments (unless they are private patients in a public hospital).
Accounts will be handled as follows: