Anaesthetic fees

There are many factors that have lead to increasing out of pocket costs associated with Medical Specialist fees in recent years. The most significant being the lack of increases in medicare rebates for many years, and health funds increasing rebates by considerably less than the rate of inflation and rate of rise of costs of practice. 

Anaesthetic billing is based on the Medicare Benefits Schedule and the Relative Value Guide, which is published by the Australian Society of Anaesthetists (ASA). A variable number of "units" are assigned to every anaesthetic given. Units increase with more complex surgery, sicker patients, longer operation times, emergency surgery, and if certain additional procedures are performed during the anaesthetic. A short procedure such as a gastroscopy may be around 9 units, while a major operation taking 10+ hours may approach 100 units.

The Medicare benefits schedule currently values 1 unit at $21.70, but the government only pays out 75% of this - around $16. This amount hadn't increased for 7 years prior to 2019, and even before the 2012 freeze had never been increased as much as inflation. The Australian Medical Association (AMA) and ASA value 1 unit at $96. This is based on inflation and increases in practice costs since medicare was established in 1984. Each health fund values units differently, but they currently range between $35-$38 per unit.  The difference between my unit rate and your health fund rate, multiplied by the number of units for your procedure, becomes your out of pocket cost, or gap.

Each Anaesthetist is essentially a small business, and must set their own fees independently - we are not allowed to agree to all charge the same fee as this is illegal - so there will usually be a difference in fees between anaesthetists. Most Anaesthetists charge somewhere between the health fund and AMA values mentioned above. I charge well below AMA rates, to keep my fees affordable and fair for my patients.

Because of the above, there will usually be an out of pocket cost for your anaesthetic fee.

I participate in "known gap" schemes with most Australian private health insurers, and for many surgery types* members of these health funds will have an out of pocket amount less than their fund's known gap limit (commonly set at $500). If a known gap scheme is used, you will only have to pay your gap amount, not the full anaesthetic fee, as I bill your fund directly for the remainder of my fee. Surgeries where 

NIB insured patients will have to pay my full fee and then claim a rebate from NIB and Medicare. Uninsured and cosmetic patients will be required to pay my fee upfront prior to their procedure. 

You will be contacted on my behalf prior to your procedure, and should receive an estimate of out of pocket fees in advance from one of the companies below.

For procedures in:

Sydney - 9A Anaesthetics     (02) 9487 3033

Central Coast - Gosford Anaesthetic Clinic    (02) 4324 7370

*excluding weight loss surgery, cosmetic surgery, reconstructive plastic surgery, and other major procedures