Insurance


Oral & Maxillo-Facial Surgery

Surgical procedures performed in this speciality are either in the fee schedule for medical services, as defined by the Federal Government, or a schedule fee for dental services, as defined by the Australian Dental Association.

Our practice endeavours to provide you with a professional service

It is our responsibility to provide you with a professional service. To deliver this service our fees need to be set at a certain level. We endeavour to keep our costs as low as possible, while still providing quality service to you, our patients. As an indication to our fee structure, approximately 70% of all the fees received go towards the practice overhead costs.

Who do you send the account to?

When medical procedures are preformed, partial reimbursement is claimed on Medicare, but a GAP payment will be required.

For Privately insured” patients, under certain circumstances, there is an additional reimbursement to reduce this Gap payment. With dental procedures the Privately insured” patients receive only partial reimbursement from their insurance company. Self-insured” patients are unable to claim for dental accounts. Overseas visitors may need to check if they are covered by the reciprocal agreement with Medicare or their travel insurance.

Private Health Insurance variations

Each insurance company has its own rules and regulations with multiple policy choices. You need to be aware of the advantages, disadvantages and limitations of your own policy.

The reimbursements are variable and dependent upon level of cover and the schedule of fees. Even so the reimbursements are designed only to cover part of your costs; there is a GAP.

Private Health Insurance determinants

They regulate conditions and procedures that attract reimbursements, namely:

  • Pre-existing conditions may not be covered
  • A qualifying period before entitlement to insurance cover
  • Some procedures have item numbers but no reimbursement
  • Cosmetic surgery has no rebate

There is no regulation as to how insurance companies determine reimbursement levels, resulting in wide fluctuation. The insurance company decides your maximum reimbursement through your membership cover with them.

Private Health Insurance reimbursements

Insurance companies are not required to disclose how they determine these levels.

  • Level of cover for the procedure
  • Maximum yearly amount allowed
  • If unused reimbursements can be extended into the following year(s)

If you don’t understand the reimbursement level of your account you may not be alone!

If you have any questions regarding your insurance or have a problem with a reimbursement level contact your insurance company. If you are still having problems our surgery can help but only to a very limited degree. Remember the contract is between you and the insurance company.

Private Insurance and Medicare are designed to share some of your Oral and Maxillo-facial treatment costs.

Ultimately all Patients are responsible for their accounts. We strongly suggest you contact your insurance company and/or Medicare with the estimation we provide before you undertake the suggested treatment.