It takes a rocket scientist to understand the financial aspects of our health care system writes Dr Amira Sanki, Specialist Plastic Surgeon and Australasian Society of Aesthetic Plastic Surgeons Chair of Education.
Health fund rebates, Medicare rebates, schedule fees, no gaps, bulk bill, assistant fees, implant costs, incidental costs….what do all these words mean?
When the doctor becomes the patient
I was having a particularly busy day last May. So busy that I didn’t have time for lunch and was happy to find a hard piece of liquorice “chew chew” in my work bag. So busy that I didn’t have time to suck my “chew chew” and ended up grinding down hard on a sharp wedge of liquorice that split one of my canine teeth. I was devastated. I spent the rest of the day chatting to my patients while in significant pain and then cried after the dentist told me I would need to have the tooth pulled. Being a pirate is NOT a good look for a Plastic Surgeon.
But once the hurt of my ageing tooth passed, the agony of the cost of a dental implant started to take effect. The news of my dental extraction, dummy tooth insertion and three stages dental implant was drip fed to me. The financial hit came in increments that were almost as sharp as the initial piece of liquorice that delivered me into the dentist’s chair.
I was truly financially cranky because financial consent was not a part of my dental implant process. No one sat me down in a quiet room and gently talked me through the costs. I am now very grateful to have had an uncomplicated dental implant, but I had taken my own thorough practices for financial consent for granted. Plastic surgeons are well and truly the most upfront, efficient and experienced doctors in delivering financial consent. Ironically, this is because our surgery is elective. Patients make the decision to go ahead with their procedure and significant choice in picking the surgeon, hospital and devices they would like to use. If the price is not right, they can elect to get a second opinion or not go ahead with the procedure.
What is financial consent?
Financial consent is an accurate estimate of your fees which you agree upon before surgery. I say approximation because unfortunately, no surgeon has control of Medicare, hospital costs or mother-nature. In my practice, a patient will receive the following:
- Day of consultation: Surgeon and Surgical Assistant’s fee estimate and expected rebate. A rebate can only be expected if the procedure has a Medicare item number. For example, a breast lift only attracts a rebate from Medicare if two-thirds of the patient’s breast gland sits below the inframammary fold and their nipples point downwards. Also, patients are given a “Booking process” information sheet to explain the NSW Medical Board rules about cooling off periods, and expectations regarding surgical deposits, refunds, cancellation fees and the costs of revision surgery.
- Within seven (7) days of consultation: Hospital estimate, anaesthetist’s estimate and cost of medical devices, e.g. breast implants.
- Day one (1) post-operatively: A surgical receipt is issued to the patient which can then be taken to Medicare and the patient’s health fund to collect their rebates.
Australians right to choose
Traditionally, medical and surgical professionals have not felt the need to provide detailed financial consent as they deem their services essential. It is important to realise that Australians are remarkably fortunate to have the ability to choose their doctor. You should always ask what the costs of surgery are before agreeing to a procedure. If it seems too much, then call other doctor’s rooms for an estimate or speak to your GP about an alternative person to see.
The final important point is that all necessary surgery is covered by Medicare. Any Australian requiring surgery to treat cancer or trauma (e.g. hand fracture) can have this surgery performed, for free, in the public health care system.