Financial Information

The Medicare Benefits Schedule (MBS) is a listing of the Medicare services subsidised by the Australian Government. It details how much financial assistance the government will provide to assist patients with the cost of health care provided by a private specialist such as an orthopaedic surgeon.

A gap is the difference between what the surgeon charges and the Medicare rebate. For surgical procedures, part of this gap is covered by the health insurance provider. The remainder of the gap represents an ‘out of pocket’ expense for the patient.

No Gap Insurance is an agreement between medical specialists and insurance companies whereby the health insurer covers the cost of the health service with no out of pocket expense to the patient for the doctor’s bill.

The AMA Schedule is a listing of recommended fees for medical services that is produced regularly by the Australian Medical association (AMA). These fees are generally higher than the MBS. At SOTRS, our fees are at (or near) AMA rates. We are happy to negotiate all fees with all patients, especially if their GP indicates a special need for cases of financial hardship. All patients undergoing surgery are given written quotes well in advance, such that gap-fees are known pre-operatively, and again these can be negotiated to agreed figures in the case of special financial requirements.

An Item Number is a code which identifies a particular medical service or procedure. These numbers are used to generate accounts for patients, Medicare and insurance companies. A single operation may involve a number of different item numbers depending on the exact nature of the procedure. Item numbers will appear on pre operative cost estimate for surgery.

“No-gaps” schemes are available for selected cases, depending on the circumstances, and all DVA, TAC and Workcover patients are treated at no personal charge for consultations or surgery (TAC and Workcover will need prior written approval).