Dr BenGreen - First Appointment Information

Disability access

All sites are fully wheelchair accessible and feature designated disabled carparks that are readily available for convenience and ease of access.

Rescheduling or running late for your appointment

Rescheduling

All efforts will be made to offer an appointment time that is suitable to you. If you need an early or late appointment, please let the reception staff know when you make your appointment. We can NOT guarantee a particular time, day or date will be available but will do our best to find a suitable time.

If you need to reschedule, please just phone the rooms on (07) 32263800 as soon as possible so a new appointment can be made, and your position can be offered to someone else. Failure to notify may result in any pre-paid fees being forfeited

Running late

We understand that this can happen for many reasons (traffic, children etc.). If this occurs, please phone the staff and let them know. We will always do our best to accommodate if time permits. Dr Green usually runs on time and has solid bookings. If you are more than 5 minutes late it is quite possible we will not be able to see you on that particular day and you will need to reschedule.

Fees explained

Each surgical procedure that is performed has a specific identifier known as an MBS Item Number, which plays a crucial role in determining the associated Surgical Fee. This Surgical Fee consists of various components: the Schedule Fee, which reflects the amount established by Medicare for the specific item number. Medicare will reimburse 75% of this Schedule Fee, a payment commonly referred to as the Medicare Rebate. The remaining 25% of the fee is typically covered by your health fund. In instances where any fee surpasses the established Schedule Fee, the additional charge is referred to as a Gap Fee, and this will be discussed in further detail later on.

There are three distinct types of ways in which fees are applied for surgical procedures. Various health funds and specific procedures will be billed according to one of these methods. The complexity of the surgery, the particular details of the health fund involved, and the nature of the surgical procedure will all significantly influence which type of fee is ultimately applied. The different categories of fees that may be applied are explained in detail below for your better understanding.

• No Gap

• Known Gap

• AMA fee / Gap Fee

No Gap

This type of fee structure is not commonly applied in most medical practices. A No Gap Procedure results in the total fee being sent directly to your health fund, with the added benefit of no out-of-pocket gap fee being required from the patient.

This specific billing approach is only implemented in certain defined situations, particularly in the management of complications arising from surgery. Additionally, any unforeseen or unplanned surgical procedures that relate to your initial diagnosis will often be billed using this No Gap method. For instance, if breast cancer surgery necessitates an additional re-excision of a margin, this will typically be billed as a No Gap procedure.

Unfortunately, it is important to note that this method cannot be routinely applied to all surgeries, as the fees disbursed by health funds have not kept pace with the Consumer Price Index (CPI) and therefore do not reflect the true value of the surgical procedure performed.

Known Gap

The Known Gap fee results in the payment of a predetermined out-of-pocket gap fee that patients need to be aware of. This known Gap fee typically ranges from $250 to $500, depending on the specific procedure being performed and the particular health fund that the patient holds.

It is important to note that only certain health funds participate in the Known Gap program. Unfortunately, patients with NIB health insurance are not able to access the benefits of the Known Gap program. As a result, NIB patients will be required to pay the AMA Gap fee, which will be described in more detail below.

MEDIBANK Private has a maximum Known Gap fee set at $400. However, for certain procedures, patients with MEDIBANK Private insurance may not be able to access the Known Gap program.

It’s significant to understand that Known Gap fees are only applied in a limited number of specific conditions, particularly for some cancer-related procedures. The application of this fee will largely depend on the complexity and nature of the procedure you require. Importantly, the Known Gap program is NOT available for breast reconstruction, explant surgery, breast reduction, or breast lift procedures.

AMA fee/Gap fee

Fees for medical services are based meticulously on the Australian Medical Association (AMA) recommendations. These fees are carefully determined by considering various factors such as the complexity of the surgery, the time required to perform the procedure, and the level of expertise needed.

The Medicare schedule of fees, which was established in the 1980s, has regrettably remained unchanged over the years. Unfortunately, the cost of providing medical services has significantly increased over the last two to three decades. As a result, the Medicare schedule does not accurately reflect the true cost of your surgery. This discrepancy has led to a gap between the actual costs incurred and the rebates you may be eligible for.

Importantly, the Medicare rebate will only cover 75% of the scheduled government fee, while your health fund is expected to cover a portion of the remaining fee, potentially up to the full total of this scheduled fee. However, any amount above the scheduled fee will result in a Gap Payable. Regrettably, nearly all health funds fail to cover the actual costs associated with the surgery, which leads to a shortfall between the recommended AMA fee and what is provided through your combined Medicare and health fund rebate. This financial difference is commonly referred to as a ‘GAP PAYABLE.’

Dr. Green's policy is to keep fees as low as possible while maintaining the highest standards of care and professionalism. He is committed to providing you with a further detailed explanation of any fees and costs during your appointment.