Billing and Health Funds

Information About Health Funds

Anaesthesia fees are determined by calculating a total number of fee units. The total number of units varies from 8 (for very short and simple procedures) to more than 30 (for longer and more complex procedures. Your anaesthesia account is calculated by multiplying the number of anaesthetic units by a dollar value per unit. Each anaesthetist determines their own unit value but most charge substantially less than the AMA suggested fee.

  • AMA Suggested Fee - $83 per unit
  • Medicare Schedule Fee - $19.80 per unit (24% of AMA Fee)

The refund that you get for doctors bills depends on which health fund you are in. The minimum amount that they have to refund is the Medicare schedule fee, which is only 24% of the AMA suggested fee for anaesthesia. Most health funds refund about 46% of the AMA suggested fee. Some health funds will only refund more than the minimum if doctors agree to charge exactly what the health fund tells us to charge. If the doctor charges his/her usual fee then these health funds will only refund the minimum they legally have to. These are called ‘No-Gap” health funds.

All other health funds will pay their higher refunds regardless of what your doctor charges.

Most specialists don’t allow health funds to tell them what to charge because

  1. We need to adjust our own fees in order to run our practice and make a living.
  2. We do not want health funds to be in a position where they can have control over other aspects of your treatment and how much it costs them (as occurs in the USA).

The following health funds are likely to have higher ‘out of pocket’ expenses: NIB, HBF, Manchester Unity, Frank, Latrobe, Mildura and Basic Australian Unity Policies

Places to Look For Advice About Health Insurance

  • - (NB. look through the list of restricted health funds to see if you qualify for them)
  • Health Insurance Brokers –
  • Health Insurance Consultants Australia –
  • iSelect – limited selection of participating funds
  • Health Link – limited selection of participating funds