The first thing to understand is the difference between inpatient and outpatient services.

If you are admitted to hospital, then this is an inpatient service. It can be a day stay of only a few hours, or weeks of care in intensive care, a general ward and a separate rehabilitation hospital. Inpatient care can include consultations with doctors, X-rays, Ultrasounds, MRIs, blood tests, infusions. Basically any aspect of medical care can be provided as an inpatient, but you have to be admitted to a hospital. The costs of inpatient services are covered by you - the patient, your private health insurer, and Medicare. How much each pays depends on the type of service provided, the location of the service, and the amount charged. The GAP is what you pay. We will talk about that later.

If you are not admitted to hospital, then this is an outpatient service. You might be seeing Mr Knight, or having an X-ray, or having an injection, or having a MRI etc. Again almost any medical service can be an outpatient service, except an operation or invasive procedure. The costs of outpatient services are covered by you - the patient, and Medicare. The GAP is what you pay on top of Medicare.

Most of medicine takes place in a face to face consultation between doctor and patient. When you see Mr Knight these consultations are billed as either an "Initial Consultation" which uses the Medicare code 104, or a "Subsequent Consultation" which uses the code 105.

If these consultations occur at the hospital bedside they are billed to your health insurance company directly, they are "inpatient services". Mr Knight does not charge a GAP on these consultations. This is because you didn't ask to see Mr Knight, your hospital team asked him to see you. There was no "informed financial consent"

If these consultations occur in an office they are billed to you, they are "outpatient services" and you cannot use your private health insurance. You will have to pay a GAP. How much GAP depends on lots of things, but it can be as much as $150. We can usually send your account directly to Medicare and you should receive a rebate directly into your nominated bank account. Currently a 104 is billed at $220, and a 105 is billed at $110. These are not timed consultations. Sometimes they are very long and sometimes they are very short. Sometimes a 105 lasts much longer than a 104. This system is far from perfect, but it is the only one we have at present. Mr Knight does not bulk bill.

Steroid injections can be done in the outpatient office setting. The current price for these is $100. There is no rebate because there is no Medicare number for joint injection. This fee covers the cost of the chemicals, the consumables and the time required. These injections are done as a convenience to you. They can also be done by a radiology service at much higher cost to you. Unfortunately these injections can only be done in locations that can be felt through the skin. These are: Shoulder, Elbow, Wrist, Finger, Trochanteric (Hip) Bursa, Knee, Ankle, Foot.

Other locations, such as the spine and the hip, require radiological guidance, and cannot be done in the office.

Operations and painful procedures require an anaesthetist. These are all inpatient services. These will be funded by you, your private health insurer and Medicare.

If you don't have private health insurance, see the next section.

These services will generate bills from multiple parties. You will get a bill from Mr Knight, the anaesthetist, the assistant if required, the radiology provider if required, the pathology provider if required and the hospital physician. All of these bills will be under a doctors' name. You will never meet most of these people. If you have a question about your bill, please ask Mr Knight. The hospital will probably also charge you an excess.

We will do our best to provide a quote and fully informed financial consent before any procedure. If you have any queries, please ask.

If you do not have private hospital insurance Mr Knight will still see you and help sort out your problem. He will then refer you to a public hospital.

No one has to have private health insurance. We have an excellent public health system. The care in public system is sometimes superior to the private health system. You will never get a bill if you go to a public hospital. Medicare - the people of Australia pay your bill.

Anyone can have an operation in a private hospital, but you - the patient - are ultimately responsible for the cost of this.

Private hospitals offer faster access and sometimes superior care, but usually just the same level of care compared with the public system.

If you have enough money you can pay for your operation without private hospital insurance. This is called self funding. This is very common for less expensive procedures. It is very uncommon for complex expensive procedures.

Please discuss self funding with Mr Knight if you wish to consider this option. Mr Knight will not suggest it himself during a consultation.

There is no way to answer this question.

If you had BUPA Known Gap Gold Level insurance Mr Knight would charge you $500 for the operation 51011 Single level fusion.

If you had Latrobe Gold Level insurance the bill would be closer to $1200 for the same operation.

However the monthly premium for Latrobe is less. So maybe you are better off in the long term. Only you can work this out.

Gold / Silver / Bronze.
The most unhappy patients in our practice are those who think they are insured for surgery, only to find out they are not. If you do not have the correct level of insurance then you have to wait 12 months to obtain cover. Having tiers of insurance is gambling. No one really knows what health problems they will have. Mr Knight has done hip replacements and spinal surgery on 30 year olds. It's rare, but it happens. You have to decide what suits you, but we always recommend having the most extensive cover you can afford.

We capitalise the GAP because it is the most polarising aspect of medical care. Everyone hates the GAP. If you are paying $1000s of dollars each year for health insurance then why should you have to pay a GAP?

This is the AMA explanation of the medical fee GAP:
A medical gap (or out-of-pocket cost) is the difference between your doctor's fee and the combined amount of the Medicare rebate and the benefit your private health insurer will pay for a medical service. Government Medicare rebates have not kept pace with the increasing costs of delivering treatment.
The AMA has long campaigned for better indexation of Medicare schedule fees. Since 1999, we have included a fee gaps chart in the AMA Fees List to show the ever-widening gap between the indexation of Medicare schedule fees and the indices for CPI, average weekly earnings and AMA fees.
The AMA Gaps poster illustrates how successive Governments have failed to index the Medicare schedule fees in line with the CPI and average weekly earnings.
With year upon year of indexation that has been well below par, today there is now quite a disconnect between Medicare schedule fees and the realistic cost of providing the services.
The fees doctors charge patients for their professional medical services must cover their practice costs. Every private practising medical practitioner incurs a wide range of practice costs in order to provide a high quality services to patients.
The costs of running medical practices vary across the country, and across speciality groups. But every medical practice, be it a sole practitioner or a large corporate practice, incurs the cost of employing administrative and clinical practice staff, general running expenses such as computers, rent, electricity, professional indemnity insurance and in most cases the cost of medical equipment and supplies.
The practice costs must all be met entirely from the fee charged by the doctor for the medical services he/she provides to patients.

TAC and WorkSafe are the most common Victorian third party payers.

Third party means someone other than you - the patient, or Medicare - the Australian people. It can also include Workcover schemes from other states or payments from legal settlements.

Payments from third party payers are done outside of Medicare. You cannot get a Medicare rebate, and a WorkSafe payment. It is one or the other.

The complexity of dealing with these systems is too great for our small practice.

This means Mr Knight only deals with you and Medicare.

Mr Knight does not treat any TAC or WorkSafe or similar cases.