Billing

Our consultations are billed according to the AMA. However we also participate in no gap & known gap medical insurance policies and charge less than the AMA recommended fee for most surgical procedures, minimising out of pocket charges. Diagnostic Angiographic procedures do not attract any gap payments.

We are very compassionate to the financial needs of the community and apply a discount to Pension Card holders.

All Veteran Affairs patients are billed directly to the Department of Veteran Affairs.

All patients who are booked for any surgical procedure will be given an informed financial consent, which needs to be signed and returned to our office prior to any procedure. All patient GAPS are to be paid prior to any surgical procedures.

Out of pocket expenses (GAP)

A ‘gap’ is the amount you pay either for medical or hospital charges, over and above what you get back from Medicare or your Private Health Insurer. Some health funds have Gap cover arrangements to insure against some or all of these additional payments.

Before you go to hospital, we will provide you with an estimate of costs for Mr Holdaway’s services. We will also advise you who your Anaesthetist and/or  Assistant will be, so you can contact then to find out about any Gap they may charge.

It is important that you understand what you are covered for with your Private Health Insurer so recommend you contact them after your booking is made sure you are covered.

Hospital Gaps

Many hospitals have arrangements with health funds to fully or partially cover costs relating to hospital accommodation. If you go to a hospital that does not have an agreement with your health fund, you may face significant out-of-pocket expenses for your treatment.

If your health insurance policy has an excess or co-payment, you will have to pay the agreed amount of excess or co-payment towards the cost of hospital treatment out of your own even if your hospital has an agreement with your fund.

Medical Gaps

Mr Holdaway participates with all Health Funds and their schemes however may choose to ‘opt out’ at any time. A select set of procedures performed through our Practice are not covered under the Gap scheme. This will be advised at the time of booking your procedure. For all other procedures, we have agreements with all Health Funds to cover the doctors fee with a caped out of pocket expence, this out of pocket will depend on your Health Fund and level of cover.

The Government does not set doctors fees and the doctor is free to decide on a case-by-case basis whether he or she wishes to use an insurer’s gap cover arrangement.

Prosthesis

A prosthesis is an antificial substiture for a missing body part, used for functional or cosmetic reasons or both. Surgically implanted prosthesis are sometimes required during a medical procedure, such as a stent graft, coil, venous valve etc.

For medical procedures covered by the Medical Benefits Schedule (MBS), your health insurer will fully cover the cost of at least one prosthesis, if require (called a ‘no gap’ prosthesis).

In some cases, an alternative prosthesis may be required which costs more than the ‘no gap’ option. If one of these prostheses is used, you will have to pay the difference between the ‘no gap’ amount and the total amount charged by the supplier for the prosthesis.

For each procedure, you should check with your health fund if you are covered, how much your policy will pay for an particular prosthesis, and whether you will have any ‘gap’ to pay.

Medicare Safety Net

Medicare Australia introduced the Safety Net for all persons with a Medicare card for outpatient services.

All Concession card holders and families eligible for the FTB (A) who spend over the Medicare Safety Net cap, can claim an additional 80% of out of pocket costs associated with any medical outpatient service (some vascular services are capped), i.e. doctor’s appointments, procedures performed not in a hospital, pathology services, etc.

Please click on the link below if you would like to visit the Medicare website:
www.humanservices.gov.au/individuals/medicare

If you would like to download a copy of the Medicare Safety Net Registration Form, please click on the link below:
Application Form