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private Fee Patients doctor

About Private Fee Patients

Our practice treats private fee patients.

If you choose to be treated as a private patient you will be able to:

  • Consultation Fees - checkmark iconChoose your own treating specialist
  • Consultation Fees - checkmark iconBe treated at hospitals that our doctor is affiliated to or is a visiting medical specialist

After discharge, your care and follow up appointments will be carried out by your specialist and team in either

  • Consultation Fees - checkmark iconAn outpatient clinic or in our private rooms
  • Consultation Fees - checkmark iconWill be referred to your local general practitioner

As a private patient, our surgeon will personally perform your surgery and provide care during your inpatient stay. All follow-up appointments will take place in our private rooms.

Overview of Payment for Patients

This page explains of practice and payment policies relating to:

the billing types our practice offers,

the billing policies for our medical services, and

further explanations to common fee questions patients have.

Types of patients

Our practice treats the following types of private patients:

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  • Blue Checkmark

    Privately Insured Patients

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    Veteran Affairs Patients

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    Overseas Patients

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    Insurance Patients

  • Blue Checkmark

    Self Insured or Un-Insured Patients

More people are opting to self-fund their surgery to avoid waiting times. This allows for immediate or flexible scheduling, facilitating a quicker return to work and sports. Patients can choose private admission even without private health insurance, but they are responsible for all admission costs except those covered by Medicare. For more information about private patient options, please contact our rooms.

If you have any billing issues or concerns, our staff is available to assist you in understanding charges and rebate structure.

Self-funded patients are responsible for the following payments:

  • Other Payment section checkmark

    Gap between Medicare benefit and specialist's charge

  • Other Payment section checkmark

    Gap for diagnostic services (some services may be bulk billed to Medicare)

  • Other Payment section checkmark

    Hospital accommodation fees (bed charge)

  • Other Payment section checkmark

    Surgically implanted prostheses

  • Other Payment section checkmark

    Other services

Fee Estimates

Prior to surgery, we provide comprehensive financial consent to our private patients. This estimate outlines your surgical costs. Our practice follows the Australian Medical Association fee schedule, but there may still be a "gap" between our fee and your Medicare and health insurance coverage. The estimate includes item numbers for discussion with your insurance company regarding coverage and benefits.

health Fund background #1health Fund background #2

Questions to Ask Your Health Fund

When talking with your Health insurance company you should be clear on the following matters:

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    What service limits apply to my cover?

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    Do I have a waiting period? And when does it end?

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    When does my annual benefit limit expire?

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    What kind of Surgical treatment is not covered?

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    What are my annual benefit limits for General Surgical and Major Surgical treatments?

About Our Fee Policy?

Australia's medical fee rebate system is complex.

The Medicare Benefits Schedule (MBS) sets fees for medical services, but surgeons can charge their own fees. Medicare covers 75% (in-hospital) and 85% (out-of-hospital) of the MBS fee. Our fees consider various factors and costs, while Medicare rebates remain the same. Surgeons determine fair fees based on individual cases and circumstances. Due to variations, estimates for operative procedures may require a clinical consultation.

Fee policy main image

Medicare Gap for our Patient Services

There is an 85% rebate provided by Medicare for outpatient services, but private health insurance does not cover the remaining amount.

This creates an "out-of-pocket" charge for patients, which includes 15% of the MBS fee and any additional fees charged by the doctor. Private health insurers are not permitted to cover doctors' fees for out-of-hospital services. Medicare benefits levels set by the government have not kept pace with inflation and rising practice costs, resulting in a widening gap between fees and benefits.

Our practice has carefully considered costs and relevant circumstances to determine fair and appropriate fees for the services provided.

patient Services Heart Image

Why is there a Gap?

Patient Services Image

This graph clearly highlights why the gap between reasonable fees based on the costs of running a practice and the Medicare reimbursement has progressively widened.

  • a) AWE = average weekly earnings CPI = consumer price index
  • b) Medicare Benefits
gap policy background #1gap policy background #2gap policy background #3

No Gap, Low Gap and Known Gap Policy

Every person who has surgery cover with any Australian health fund and who are in significant financial hardship may be covered by our No Gap Policy. This means some patients may receive no or low out-of-pocket expenses for some treatments . Our practice believes strongly in the importance of appropriate surgical care.

We offer clear fee schedules for our patients, with service fees ranging across

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    No Gap

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    Low Gap

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    Known Gap

Conditions for the No Gap Surgical Service include you must have:

  • 1

    Basic Surgical cover with your private health insurer

  • 2

    Your health fund card with you at the appointment

  • 3

    Ensure your insurance covers the treatment cost. If your coverage limit is reached, you will be paying the remaining amount

These No Gap fees are available for patients in significant financial hardship or pensioners.

Where you are not eligible for No Gap services, you may also be eligible for Known Gap or Low Gap Fee Schedules. Please contact our practice for further details.

We also offer a “No Gap Surgical Check Up”. This includes:

  • Payment Types section checkmark

    Surgical examination and a consultation to address any and all of your questions and concerns regarding some specific conditions.

  • Payment Types section checkmarkDiagnostic examinations
  • Payment Types section checkmarkWhere surgery is required, this may also be covered by our No Gap Policy
Doctors association

Uninsured Public Patients

If you are not covered by private health insurance or other claiming system these are the alternatives:

  • Payment Types section checkmarkGo on a Waiting List at the Public Hospital
  • Payment Types section checkmarkPay for the operation yourself (“Self Insure”)
insurance card

Public Hospital Waiting List

Australian residents choosing public patient status receive free treatment under Medicare.

An appropriate specialist will be arranged for your treatment before admission. After discharge, you will continue care at an outpatient clinic or with your local general practitioner.

Surgery in public hospitals is free, but there may be a waiting list based on the severity of your condition. Follow-up visits will be coordinated by the hospital. Surgeries in public hospitals are typically performed by supervised senior surgeons overseeing registrars (doctors in training) responsible for your care.

The Waiting List for operations in the Public Hospital System can be considerable.
Currently many common procedures are upwards of twelve months.

Knee background

Do you need a

Knee replacement?

Dr Seeto in affiliation with Medibank Private and East Sydney Private hospital, offers a program for eligible Medibank Private Members, to eliminate medical out of pocket costs for your Knee Replacement.

The program includes a pre-surgery preparation program, spending the minimal time necessary in hospital, as well as home rehabilitation if necessary.

$0

Out Of Pocket

Knee operation

Book a consultation

today

Contact us

Contact info

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Suite 209, 203-233 New
South Head Road
Edgecliff NSW 2027

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(02) 9362 5975

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Appointments

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