All Australian residents are covered by the “public health system” or medicare.
In addition, the private health system affords patients the benefits of:
- The right to choose your own surgeon
- The knowledge that you will have continuity of care from the same health professional throughout your episode of care (before, during and after surgery).
- Access to medical care in a more timely fashion and in an Institution of your choice
- No long waiting lists
The majority of private health fees are covered by medicare, with private health insurance funds also contributing an amount.
Most doctors’ costs are paid for by Medicare, with health insurance companies supplementing a small, additional, amount. In fact most of your health insurance goes to paying for your hospital stay, operating theatre fees and costs of any implant/prostheses, not the doctor’s costs.
There is usually a difference between the private health fees and the amounts paid by medicare and health insurers. This difference is known as the ‘GAP’. The GAP is the amount that patients will be ‘out of pocket’ for after the service has been paid for by Medicare and the health insurance company. This varies depending on the service provided.
Dr Gomez and his anaesthetists participate in the ‘known GAP’ billing system with most private health funds. This generally means your GAP will be fixed at $500 each for the surgeon and anaesthetist. There may be some exceptions to this on a case by case basis.
This fee varies depending on the length of consultation. Initial consultations are usually of longer duration, and the fee is therefore higher. Subsequent consultations generally require less time thus have a lower fee.
While Dr Gomez’s secretary can provide an estimate of fee’s for the your surgical treatment, uninsured patients will need to contact Hillcrest hospital to obtain a quote for the fee’s associated with theatre, hospital and prosthesis costs.
Workcover and Veterans’ affairs
Dr Gomez accepts Workcover and Veterans’ affairs referrals, and bills these organisations directly with no out of pocket expense to the patient.