FEES
The Australian Medical Association (AMA) publishes a range of suggested fees for medical services. The fees I charge are within the AMA guidelines and are calculated based on the complexity of the case and the duration of the procedure.
Fees may increase for:
- After-hours services
- Emergency situations
- Call-backs from home
An accurate fee estimate will be provided by telephone 1–2 days before your surgery. This estimate will come from the team at Complete Anaesthetics. If you require an estimate earlier than this, please use the link provided below.
Why Is There a Gap Charge?
A gap fee is an out-of-pocket expense you may need to pay when the rebates from Medicare and/or your private health fund do not fully cover the doctor’s fees.
Some health funds report that 70-90% of anaesthetists do not charge a gap for their patients. However, this statistic varies by location. In New South Wales, particularly in larger cities like Sydney, a higher percentage of anaesthetists charge gap fees, and the amounts tend to be larger.
Unfortunately, gap fees have become more common and larger in recent years because Medicare and private health insurance rebates have not kept up with inflation. It’s understandable to feel frustrated about paying a gap fee after already paying for private health insurance.
How are Anaesthesia Bills Calculated?
Anaesthesia fees are billed using a "unit" system, where the number of units depends on the complexity of the surgery, including factors such as:
- Type of surgery
- Duration of surgery
- Monitoring devices used
- Anaesthetic procedures performed
- Patient’s illness severity
- Patient’s age (under 12 or over 70)
- After-hours or emergency care
- Preoperative consultation (Item 17610): 2 units
- Arthroscopic shoulder surgery (Item 21622): 5 units
- Time units for surgery duration (e.g., 2 hours): 10 units
- Nerve block (Item 22050): 2 units
If an anaesthetist charges no gap, they receive about $33 per unit (set by the government and health funds), so the total charge would be:
19 units × $33 = $627
This government rate has not increased with inflation for many years.
The Australian Medical Association (AMA) recommends billing at around $106 per unit to reflect current costs and inflation. Using this rate, the same example would cost:
19 units × $106 = $2,014
This is roughly 3 times higher than the no-gap rate.
The gap fee is the difference between the AMA recommended fee and the government rebate:
$2,014 − $627 = $1,387
Some anaesthetists bill at the AMA recommended rates, while others, including myself, usually charge between the government and AMA rates, typically lower than the AMA recommendation.
Please see the diagram below for a visual explanation (NB $96 for AMA was the 2022/2023 unit rate)
