This page explains of practice and payment policies relating to the billing types our practice offers, the billing policies for our medical services, and further explanations to common fee questions patients have.
If you choose to be treated as a private patient you will be able to:
choose your own treating specialist, and
be treated at hospitals that our doctor is affiliated to or is a visiting medical specialist at the right time.
After discharge, your care and follow up appointments will be carried out by your specialist and team in our private rooms.
As a private patient our surgeon, Dr Lawrence Kim will perform your surgery personally and will also look after you if you are advised to be an in-patient. All follow up appointments will be in our private rooms.
With the security and protection of private health insurance, you have access to an extensive range of private hospitals and can rest assured that your health is in good hands.
Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated.
You should be aware that:
Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with the AMA fee schedule.
Different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.
Depending on your level of cover, some health funds also require you to pay an excess. We are not responsible for these costs but our staff will do their utmost to guide you to better understanding.
Our practice accepts most private health insurance programs. Our staff can also help with your claim for benefits, but we remind you that your specific policy is an agreement between you and your insurance company.
- Insurance Claimants include two common insurance classes are:
- Workers Compensation, and
- Motor Vehicle Accidents
- Third-party accounts
If your account is being paid by a third party, we will require a letter from the third party stating that they will cover a particular service prior to your appointment or procedure. Without this we are unable to send the account to a third party and we will require you to settle your account on the day of your appointment.
Workcover and Workplace Injuries
We offer full Workers Compensation and work-related injury treatments.
If you are seeing the doctor for an existing Workcover claim or if you have recently been involved in a work incident and are unsure of whether you fall under the category of WorkCover, please inform the receptionist on arrival.
We know the importance of good communication with employers to minimise lost time from injuries, and we work with employers to find alternative duties for injured staff where possible.
Motor Vehicle Accident (CTP) Claimants
We offer full CTP Injury treatments.
If you are seeing the doctor for an existing CTP claim or if you have recently been involved in a transport accident and are unsure of whether you fall under the category of CTP please inform the receptionist on arrival.
The Australian Government’s Department of Veterans’ Affairs (DVA) provides support to current and former serving members and their families through a range of benefits.
These can include both ongoing or one off payments.
For further understanding on how you can apply these benefits to our service and the scope of cover please refer to: http://www.dva.gov.au/benefits-and-payments
If you do not have private health insurance, you can still choose to be treated in a private hospital, by self-funding your medical care. If you choose to self-fund your care, you will not be eligible for any rebate of your hospital fees. You would be eligible for a Medicare rebate for a portion of your surgeon’s fees, surgical assistant fees and anaesthetist’s fees. Dr Kim’s staff will compile a quote for the anticipated fees for Dr Kim, his surgical assistant, his anaesthetist and if possible hospital costs. It might take a few days to arrange this, as we need to liaise with the hospital administration.
Self-funded patients will be liable to pay the following:
The gap between the Medicare benefit and any specialist’s charge
The gap for diagnostic services (medical imaging and laboratory testing), however some of these services may be bulk billed to Medicare, that is no ‘gap’
- Hospital accommodation fees (bed charge)
- Surgically implanted prostheses
- Other Services
Essentially this means you must meet all costs of the admission yourself except those covered by Medicare.
For further information about being a private patient, contact our rooms
Non Reciprocal Health Care Agreement – If you are an overseas patient from a country where there is no Reciprocal Health Care Agreement, you are not eligible for Medicare and you are responsible for payment of all fees and services. Non-Medicare patients are billed for inpatient and outpatient services regardless if they choose public or private admission.
Reciprocal Health Care Agreement – If you are a visitor from a country where Australia does have a Reciprocal Health Care Agreement (RHCA), you may be eligible for treatment that is deemed immediately necessary for any health problem or injury whilst in Australia. RHCA does not cover pre-arranged or elective treatment. Overseas patients who are covered by the RHCA will not be covered if they choose private admission.
Please contact us for more information.
If you are not covered by private health insurance or other claiming system you do not need to be worried about it.
Dr Kim offers a wide range of diagnostic, medical and surgical services at Westmead and Blacktown hospitals.
If your require surgery there are two alternatives:
Go on a Waiting List at the Public Hospital, or
Pay for the operation yourself (“Self Insured” or “Self Funded”)
Australian residents who decide to be a public patient are entitled to free treatment under Medicare. Your treatment will be carried out by an appropriate specialist which will be arranged prior to your admission. After discharge, your care will either be continued in an outpatient clinic or you will be referred to your local general practitioner.
In the public hospital, the surgery is sometimes performed by a registrar (specialist in training) but the registrar is supervised by a consultant urological surgeon who is responsible for your care.
There are no fees for surgery in the public hospital, however, there is a waiting list. Your position on the waiting list will be based on the urgency and severity of your condition. Your follow up visits after surgery will be arranged through the hospital or your specialist’s rooms.
We offer informed financial consent to all our patients prior to surgery. This is a pre-treatment estimate of your surgical costs.
While the fees charged may depend on the specific course of treatment, our practice’s standard fees are in line with the Australian Medical Association recommended fee schedule. This means that there might be a ‘gap’ between our surgical fee and what is covered by Medicare and your health insurance fund. Dr Kim is committed to charging a fair and reasonable fee and will take individual circumstances into consideration.
The pre-treatment fee estimate includes the specific item numbers to be used and enables you to discuss with your health insurance company what you are covered for and if benefits are applicable.
If there is any problem with either the fee estimate or any other billing issue, it is important that you ask our staff. They can help you navigate what can be a complex process by either advising and helping explain the charges and rebate structure.
All Fee Categories
Our practice fees for either Consulting or Surgery may sometimes only be part of your treatment cost.
Other possible fees or disbursements involved in your care are dependent on which course of action is chosen for your treatment. You may need to also check with your health fund to see what is covered for additional areas of service. Potential fee categories to be sure of can include:
- Hospital Fees – Fees are payable directly to the hospital.
- Surgical Assistant Fees,
- Implants or Prosthesis Costs,
- Medications (if listed on the Pharmaceutical Benefits Scheme (PBS) schedule, you will receive a subsidy)
- Anaesthetists Fees – Fees are payable directly to the provider.
- Diagnostic Tests (Radiology, Pathology), and
- Post-Operative Care.
Questions to Ask Your Health Fund
When talking with your Health insurance company you should be clear on the following matters:
When talking with your Health insurance company you should be clear on the following matters:
- What is my annual monetary benefit limit for:
- General Surgical treatment and Major Surgical treatment?
- What service limits apply to my cover?
- When does my annual benefit limit expire?
- Do I have a waiting period? And when does it end?
- What kind of Surgical treatment is NOT covered?
About Our Fee Policy?
The medical fee rebate system in Australia is complex. A set of fees for medical services is determined by the Federal Government and known as the Medicare Benefits Schedule (MBS). Most procedures involved in your treatment will have a MBS “item number” and the Government sets a Medicare Benefits Schedule (MBS) fee for each item number.
The MBS fee is used to work out how much Medicare will pay. Medicare pays a benefit of 75% of the MBS fee for in-hospital treatment and 85% of the MBS fee for out-of-hospital services. MBS fees are not the fees doctors charge, they are fees set by the government to manage the benefits paid by Medicare.
Surgeons are free to set their own fee for the services, these are also governed by the The Competition and Consumer Act 2010 but are under no obligation to charge fees that are equal to the Medicare Benefits Schedule (MBS) fee or the schedules of medical benefits set by private health insurers.
Our fees not only take into account the professional fees but many other factors including practice staff, office expenses, operating expenses, medical registration, compulsory professional association subscriptions, professional indemnity insurance and many other elements. These cost can vary significantly, yet the Medicare rebates are identical irrespective of the practice running costs.
In our practice specialty, prompt communication with the referring general practitioners or specialists is vital, and prompt responses, with high staff levels is a major benefit to patient care, but potentially also adds cost.
Surgeons should satisfy themselves in each individual case as to a fair and reasonable fee having regard to their own costs and the particular circumstances of the case and the patient.
The fees charged by our practice have been determined after careful study and investigation of practice costs and other relevant and material circumstances, and are considered as being fair, reasonable and appropriate for the services provided.
The same operative procedure can vary enormously in both complexity and operating time between individual patients, and as such there may be significant variations in the operation fee for the same procedure, depending on the individual circumstances. For this reason sometimes it may not be possible for us to provide estimates for operative procedures over the phone prior to a clinical consultation.
No Gap, Low Gap and Known Gap Policy
Our practice believes strongly in the importance of appropriate surgical care. We offer clear fee schedules for our patients, with service fees ranging across: No Gap, Low Gap, and Known Gap
Every person who has surgery cover with any Australian health fund and who are in financial hardship or pensioners may be covered by our No Gap Policy. This means some patients may receive no out-of-pocket expenses for some treatments .
Conditions for the No Gap Surgical Service include you must have:
- Basic Surgical cover with your private health insurer,
- Your health fund card with you at the appointment,
- Insurance cover for the cost of the treatment. If your limit is reached for services provided or your health insurer paid zero dollars, you will have to pay the difference.
Where you are not eligible for No Gap services, you may also be eligible for Known Gap or Low Gap Fee Schedules. Please contact our practice for further details.