Anaesthetist - Query about cost

My gap for the band was similar but same as shrinking violet, got financial consent done before so it wasn't a surprise.  Think my surgeon for the sleeve has a total out of pocket though so pay once for him, gas man and assistant surgeon rather than separate bills from everyone.

I paid an $800 gap for the anaesthetist above Medicare and PHI. I was pre-informed, financially consented and post billed.

I would have paid a $1500.00 GAP - this is the difference between what is charged and the MBS Scheduled fee (75 % of the MBS fee + 25 % from PHI to equal 100% of the scheduled fee).  (I actually paid him only a $500.00 gap as I had had him before for a different operation, maybe you could ask him to give you discount as you used him in the past? I did!)

So say the anaesthetist charged $2,200 for the surgery anaesthetic; and the scheduled fee is e.g. $575 and PHI is e.g. $125, then $1500 is the GAP that I paid.

What PHI does is, if you are 'fully covered' pay the remaining $$'s to take you up to what the MBS scheduled fee, not the gap between that and what you are charged.
Some Drs participate in 'no gap' so they don't charge over the scheduled fee.

Hope this makes sense?  I don't work in the PHI! 

All the best,

:)

It's also easier for the Docs office to keep two sets of accounting books if he keeps rebates and "out of pockets" seperate...if you know what I mean...wink, wink! What Medicare and PHI don't know means the ATO maybe also doesn't have to know....just saying!

Hi squeaky toy, whilst I can't answer all your questions surrounding this, I can shed some light and make some suggestions on the anaesthetist and phi fund complexity.
I Have experience with a phi fund (not the one you've mentioned but I won't mention the particular fund on the Internet).

Your fund would/should have advised you that you may have a gap/out of pocket cost, as phi funds don't usually cover more than the medicare benefit schedule (MBS) fee, or atleast part thereof. So when they say you're "100%" covered, they probabley mean to say that youre 100% covered for the MBS fee, before the doctor charges above it (if the doctor chooses to charge above it). Some doctors will agree with ur phi fund to charge a reduced gap of say $500 for example, or no gap at all (and let ur fund cover the rest), or they will just choose not to charge above the MBS fee, for certain procedures. Some procedures are more in depth than others and hence they may choose to charge higher out of pockets/gaps.

What I would suggest you do, is phone your phi fund and request that they listen to the call where you were told that you were "100%" covered, and if that is indeed what they have said, and they haven't advised you of any gap or out of pocket cost,  than they HAVE to cover it/reimburse you for the full amount. If they don't, I would be going to the health insurance ombudsman. 

I hope that makes sense. And I hope that helps xx 

Good luck with your sleeve journey :)

Hi all

I've got a query about how much people have paid for an anaesthetist for their sleeve. (I'm talking the amount that was charged not your out of pocket expense)

I was recently sleeved and used the anaesthetist that my surgeon usually works with.  I had the same surgeon and anaesthetist when I had my band removed in January this year and all of the costs of that were paid by my PHI (Private Health Insurance).

In May I had a one on one consult with the anaesthetist about 5 days pre-op and went through the process which was really a waste of time because it was nothing that I hadn't gone through nearly 4 months prior.  At that consult I paid $900 of which $106 was for the consult (I understand that I claim this via Medicare of HBF and will get a portion back).  The remainder was my understanding to be the cost of the service and once the surgery was over I would be provided with item numbers that would enable me to claim with PHI.  The invoice was stated as a co-payment but I didn't take any note of that because in the January surgery I had $0 out of pocket and was assured by PHI that this particular anaesthetist is 100% covered with them.

This week I called the offices to receive a new copy of the revised invoice with claim numbers so I can take it to PHI and get my money back.  I was told No, this is your out of pocket expense.  So at that point I'm mighty confused and I call PHI to discuss my concerns and they had a look through the service contract which said he was 100% covered.  I've sent them a copy of the invoice that I received and they are looking into the matter.  Also, whilst I was on the phone to their offices I asked what was the total cost of the procedure and they said around the vicinity of $1,300.  After logging into my PHI account I could see that they had requested a payment of $1,314.50 and received that paid in full.

In the mean time I had emailed the offices requesting an itemised copy of the services that were provided, along with the fee associated with that and the total that PHI would be rebating so that I could at least reconcile the co-payment.  I received an email back this afternoon with the same breakdown that my PHI account had and the same invoice with no item numbers that I had received from my pre-op visit.

So the total of this anaesthetics services was around the $2,200 mark.  Of which I am footing the bill for $800 which I thought was 100% covered by my PHI.  I'm bloody angry.  This was not explained fully to me before hand.  Has anyone had the same thing happen to them?   I don't understand why and how someone who has a service contract with a PHI can decide to charge above the agreed contract?  Is this normal? How can someone charge an additional fee of $800 without anything to back up what the services are?

I found the lady on the end of the phone for their offices was extremely rude and lacking in any kind of understanding.  She had said "he is one of the cheapest in Perth" is a crock of crap.  A friend used an anaesthetist that wasn't covered by any PHI and his total cost was $1,300 and of that she was $600 out of pocket.  That I understand.  This is a bill that I hadn't anticipated.