Today Medicare rebates do not cover the full cost of providing you with medical care.  This is because the rate at which successive governments have indexed the Medicare Schedule fees has been substantially lower than increases in the Consumer Price Index (CPI) and average weekly earnings.

In fact, Medicare rebates have been frozen since 1 November 2012. The Liberal government only in late 2017, announced it will slowly reintroduced indexation of Medicare Schedule fees, specialist consultations will be indexed from 2018, followed by specialist procedures in 2019.

In effect, this means that Medicare rebates do not cover the cost of providing you with a safe and high quality service.  The fees charged by this practice have to cover all of our practice costs including employing staffs, meeting our operating expenses such as rent, medical equipment, electricity, computers and a very expensive medical indemnity insurance. 

The restriction of Medicare rebate means that this practice is not able to bulk bill our patients.

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Pregnancy Care & Delivery Fees

Out of Hospital/ Clinic Consultation

Initial consultation: 

The fee for the initial consultation is higher then subsequent consultation because there is more time allocated for your initial meeting with Dr Sem. This will allow time for him to review your history, perform general physical and obstetric examinations, if appropriate also an ultrasound. He will discuss important aspects of your pregnancy and the management plan. He does not want to rush you through a very important part of your pregnancy care.

Subsequent consultation:

For subsequent consultations, the fee is lower as he will be familiar with the your pregnancy and thus have allocated the necessary time for your next appointment.

Ultrasounds during consultation:

For many of your visits, Dr Sem will perform an ultrasound to assess the progress of the pregnancy and well being your baby. There is no out of pocket cost for this service.

Pregnancy management fee:

This is a fee that is provided to offset the costs involved in managing your pregnancy. Dr Sem provides 24/7 cover to his patients with very few exceptions, such as planned holidays/ conference leave or when he is operating. The fee compensates for his time and availability as well as covers the cost of providing a safe pregnancy care, and ever increasing cost of running a private practice.

While the Medicare rebate does not cover the full cost of the fee, the Extended Medicare Safety Net can significantly reduce out of pocket costs for this, so make sure you register BEFORE you claim.

We require payment of this fee in 2 installments, at 24 and 28 weeks. You will receive a receipt for a deposit at 24 weeks and a full invoice at your 28 weeks visit. The invoice is claimable to Medicare.

Please note, pregnancy management fee is separate to your consultation fee.

If you come under Dr Sem’s care late in pregnancy, payment prior to delivery is required.

Post-natal visit:

There is no out of pocket cost.

Payment:

After the consultation, you will be provided with an invoice. The full payment is to be made for the consultation, part of which you can claim back from Medicare. Payments by EFTPOS or credit card are accepted. 

In-Hospital Care

With private health insurance cover:  

Your insurance will cover fees for the cost of the hospital bed, theatre use and some or all other costs. Dr Sem will bill your private health insurer directly for the delivery, and in most cases there is no gap. If you require other specialist services (e.g anaesthetist for epidural, paediatrician and surgical assistant for caesarean birth), you will be billed separately, and there may be a gap payable.

It is important to check with your health fund that you have family cover, and not just singles cover to ensure your baby is covered by health insurance while in hospital.

No private health insurance (self funded): 

Medicare will cover a portion of your delivery, surgical assistant, anaesthetist and paediatrician fees, and you are responsible for the balance. You are also responsible for paying the full cost of the hospital bed, theatre fee and other costs.

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Gynaecology Fees

Out of Hospital Consultation

Initial consultation: 

The fee for the initial consultation is higher then subsequent consultation because there is more time allocated for your initial meeting with Dr Sem. This will allow him to understand your concerns, take detailed history, perform a thorough gynaecological examinations. He will then formulate the best plan to treat your condition and discuss it with you.

Subsequent consultation:

For subsequent consultations, the fee is lower as he will be familiar with your condition and will not need as much time.

Post-operative visit:

This visit is generally covered by the surgical fees, unless there is a new clinical issue raised.

Payment:

After the consultation, you will be provided with an invoice. The full payment is to be made for the consultation, part of which you can claim back from Medicare. Payments by EFTPOS or credit card are accepted. 

In-Hospital Care

With private health insurance cover:  

Your insurance will cover fees for the cost of the hospital bed, theatre use and some or all consumables (surgical equipments). In most cases, you will need to pay an excess which will vary depending on your health funds and level of cover.

Dr Sem will invoice your private health insurer directly for your procedure. Usually there will be a difference (gap) between what Dr Sem charges and what the health insurer pays. His fees are guided by Australian Medical Association Schedule of Fees, which what Medicare rebates should have been if it was appropriately indexed. Please note that the gap must be settled 2 days prior to surgery.

If needed, you will be billed separately by the anaesthetist and surgical assistant. There may be gap payable for their services as well. 

Depending on the agreement between your health insurer and the hospital, there may be additional cost for inpatient pathology, medical imaging, physiotherapist and other allied health services.

Self funded: 

Medicare will cover only a small proportion of surgeon’s, anaesthetist’s and surgical assistant’s fees, and you are responsible for the balance. You are also responsible for paying the full cost of the hospital bed, theatre fee and other costs such as pathology, medical imaging etc.

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Informed Financial Consent

Procedure performed by Dr. Sem at every hospital will vary from patient to patient. The practice manager will prepare a surgical fee estimates with details of the surgical procedures,  item numbers and indicative costs.

Please contact us to enquire more about fees and out of pocket costs for all procedure performed by Dr. Sem either in Gold Coast Private Hospital or Tweed Day Surgery.

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