I'm glad it helps. It's an interesting area actually.
Ok re specialists. Look I've not used them much... so I'm unclear on this.
Generally, we have to see a GP first if we want any rebate etc. The GP gives us a referral letter then we head off to see the specialist.
At that point I think that we can go private or public. The GP will probably have asked also whether it's a work injury or transport injury. The former is covered by a seperate (employer funded) scheme, while the latter is covered by our annual car registrations.
In the one case that I can remember, I had a suspected ganglion in the wrist. I was probably about $40 out of pocket (after medicare reimbursement) for two visits to the sports medicine oriented GP.
I had Xrays, free through medicare but carried out at the private sports-med facility. I also opted to have an MRI, which wasn't covered (private or public schemes) in this case. Cost about $100.
Then I visited a specialist surgeon, in an exclusive clinic, who charged me about $100 for a short visit. About 5min only. He advised against surgery actually, at this time. Not worth it apparently. I recovered some of this fee but I'm not sure the percentage. All prices are in AU dollars.
I just did a check. Here's a quote...
Quote:
The rebate for specialist consultations is 85% of the Medicare rebate schedule.
If you have a specialist procedure, the rebate is 75% if you are treated as a private patient and 85% if your specialist works through a public hospital outpatients department.
If you have private health insurance you may receive another rebate (25% of the Medicare scheduled price for that procedure).
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My interpretation is that the medicare schedule... is the government decreed fee. My guess is that the AMA sets a higher standard fee. Insurers however have agreements with some hospitals though... if you go to these designated centres on specific schemes then my understanding is that you are gauranteed no out-of-pocket expense. This effectively promotes both the insurer and the hospital I guess - the doc probably gets less than usual and the scheme probably pays more than usual.
This is all just outpatient stuff. Hospital procedures are still free in the public system (as best I know) - but there are waiting lists, depending. Waiting lists for "elective" surgery (which I understand to mean things like hip replacements etc) are one of the key measurement criteria for the hospitals and are usually discussed come election time.
As I said though... message me if you really want to know more. It's probably much easier for me to find out these things. Both medibank and medicare have shopfronts nearby that I can visit for example.
Links, if you are interested
www.phaa.net.au/links.html (from AMA Victoria)
www.medicare.gov.au
www.medibank.com.au