costs, rebates, and billing policy
billing policy
This is a private billing practice.
All doctors working here run public hospital bulk billing clinics as well, and you are welcome to book in to these clinics by contacting the public hospitals. We do not book for the public hospital clinics through this practice. The number for A/Prof Corte’s public hospital IBD clinic, and for the public hospital general gastroenterology clinic at RPA is 9515 0056.
If you have Medicare only, these will be entirely covered by Medicare in the public hospital.
Patients can elect to self-fund and have procedures privately. If you are covered for procedures with private health, these will be covered by your private fund, with the exception of your excess (which is between you and your insurer). Procedural gaps are separate from, and in addition to, your excess.
billing information
New and follow up consultations.
New Consultation (new issue, new patient to practice, new referral): $350
Medicare Rebate: $151.90 (occasionally the rebate is higher depending on medicare criteria)
Follow up consultation: $175. Medicare rebate $76.00.
Gap Payments
Gap = Payment to be made to the doctor after the Health Fund has paid.
Excess = Payment to be made to Health Fund as agreed by you in your contract.
The specialists charge a gap, and participate as 'known-gap' providers. The gap is:
- Colonoscopy $300
- Gastroscopy $200
- Gastroscopy and Colonoscopy $400
- EUS $400
- Balloon Enteroscopy $400
Anaesthetists will charge similar but usually lower fees.
The doctors charge a Gap for all endoscopic procedures. This policy is also inclusive of our anaesthetists (you will be contacted by their rooms regarding their gap charges and particulars). Gap charges are in addition to any excess (payable on the day to the hospital). It is the patient’s responsibility to contact their health fund to determine whether an excess/co-payment is applicable.
The gap amount is dependent on procedure type (please see below list) and must be PREPAID; if you are unable to pay this gap prior to procedure, your procedure will NOT go ahead.
Patients with NIB are the exception, and will have to pay the entire private procedure fee and recoup the rebate from NIB. This is an NIB policy and we not privy to why this is.
Procedure Item Numbers
Please check with your fund that you are covered for the following item number/s:
Procedure: Gastroscopy
Procedure Item: 30473
Procedure Gap: $200
Procedure: Colonoscopy
Procedure Item: 32222, 32229 or 32230 (large polyp removal)
Procedure Gap: $300 or $400 (large polyp removal)
Procedure: Sigmoidoscopy
Procedure Item: 32084
Procedure Gap: $300
Procedure: Endoscopic Ultrasound
Procedure Item: 30694
Procedure Gap: $400
Procedure: Balloon Enteroscopy
Procedure Item: 30684 (antegrade) or 30686 (retrograde)
Procedure Gap: $400
Procedure: Any combination of procedures
Procedure Item: -
Procedure Gap: $400
Hospitals
Chris O’Brien LifeHouse, Camperdown (CC: Thur PM)
Sydney Day Surgery, Newtown (CC: Mon AM, fortnightly Fri PM)
Macquarie University Private Hospital, Ryde (CC: 1x Mon PM per month). Bookings through Macquarie clinic 98123880)
Health Fund Help
Should you have issues with your health fund provider, or you are still unsure, you can confirm your level of coverage with the individual hospitals by calling LifeHouse on 8514 1000, Sydney Day Surgery on 9550 5600.
Eclipse
Should you have issues with your health fund provider, or you are still unsure, you can confirm your level of coverage with the individual hospitals by calling LifeHouse on 8514 1000, Sydney Day Surgery on 9550 5600.
We will endeavour to process all procedures through the electronic system “Eclipse” with your private health fund. This is successful about 90% of the time.
Most of the exceptions are due to ‘paperwork’ errors that cannot be resolved by our practice (issues between you and your health fund e.g. differences in the spelling of your name, Medicare Card updates, administrative errors, etc). In the event that we are unable to process your claim with Eclipse we will contact you by telephone/email/post to receive payment (at the same rate that your health fund will reimburse you through the “no gap” scheme). We will then issue you with the necessary receipt to allow you to proceed with your health fund claim (you will not be able to claim without a receipt).
repeat prescriptions
Unless it has been agreed upon by the doctor, and documented in the notes, we will no longer be supplying repeat prescriptions without appointments.
Patient safety is at the route of this policy change. The length of repeat prescriptions is determined by the need for review of drug necessity or the need for monitoring of the patient.
Most repeat prescriptions can be conveniently obtained from your General Practitioner, who will have received correspondence from us.
If an emergency prescription is required, and can not be provided by your GP, a fee may be charged.
cancellation policy
We have a 24 hour cancellation policy.
This means that if you wish to cancel your appointment, this needs to be done at least 24 hours prior to the time of the appointment. If you do not cancel your appointment more than 24 hours prior the the appointment time, and you miss your appointment – you will be charged the full fee for the appointment. In special circumstances we may choose to vary this policy.
Cancelling procedures within 24 hours, or failing to attend a procedure without providing notice, will incur a $250 cancellation fee. In special circumstances we may choose to vary this policy.