Oral & Maxillofacial Surgery:
Surgical procedures performed in this specialty are either in the fee schedule for medical services as defined by the Federal Government or the fee schedule for dental services as defined by the Australian Dental Association.
Our practice strives to provide you with a professional and quality service. To deliver this our fees need to be set at a certain level. We endeavor to keep our costs affordable, whilst still allowing us to provide a quality service to you.
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.
Your reimbursements are variable and dependent upon your level of cover and schedule of fees. Even so, the reimbursements are designed to only cover part of your costs so you will likely have an out-of-pocket expense known as a GAP.
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.
If you don’t understand the reimbursement level of your account or you have any questions regarding your cover and policy, contact your insurance company directly. Our staff may be able to help answer your questions but are limited on the knowledge of your policy.
Dependent on the item numbers used for your procedure, you may be eligible to claim with Medicare, your private health fund or both.
At your consultation you will be provided with an estimate of costs containing item numbers and an indication on which items are eligible for a claim.
If your procedure is eligible for a Medicare claim, our staff will electronically submit this on your behalf. If you are eligible for a further claim with your private health fund, you will be issued with a receipt along with a lodgement advice to submit these to your health fund.
If your procedure is eligible for a private health fund claim, you will be issued with a receipt to submit a claim into your health fund.
Any items covering the cost for a specific product required for your treatment is non-claimable. If this is the case, this will be highlighted in your estimate of costs.
If you are uncertain where to submit your claim or if the claim has been done on your behalf, please contact our helpful staff.
Should I take out an insurance policy to cover my surgery?
In some cases, it may be beneficial to take out an insurance policy to cover you for a particular procedure, especially if it requires hospital stay and prosthetics (such as plates and screws, bone products etc). It is important when researching health insurance to determine if there are any limitations to the policy you are enquiring about:
- Waiting periods
- Pre-existing conditions
- Level of cover for the procedure required
It is also important to think of your financial position and whether taking out an insurance policy with a 12-month waiting period for your proposed treatment is going to benefit you. If you are uninsured and thinking of taking out a health insurance policy, our staff will provide you with the uninsured costs at your consultation so you can weigh up the costs and decide what is the best option for you.
Cosmetic procedures that are ‘cosmetically indicated’ are not claimable with Medicare or a Private Health fund. A cosmetically indicated procedure is a procedure that is being done purely for aesthetic reasons such as improving your appearance (Injectables, liposuction, breast augmentation).
In some cases, cosmetic procedures are ‘medically indicated’ meaning they are claimable with Medicare or a Private Health Fund. A medically indicated procedure is a procedure that is medically necessary to improve function or to treat a disorder (rhinoplasty to improve breathing, breast reconstruction to treat a breast disorder).
At your consultation with your surgeon this topic will be discussed and you will be given the appropriate quote depending on your procedure requirements.