Anaesthesia fees and gaps
Specialist anaesthesia services attract a fee separate to those charged by the hospital or other doctors caring for you. While the fee will vary depending on the complexity and duration of the anaesthesia, it is usually possible to obtain an estimate prior. Ask your doctor about the fees relating to your proposed treatment.
You may be able to claim a rebate for a portion of your anaesthetic fee from Medicare and your private health insurance fund. Often there is an associated out-of-pocket expense and the size of this ‘gap’ varies depending on your fund and your level of coverage. It is your responsibility to pay your anaesthesia fees.
Why is there a ‘gap’?
The anaesthesia fee may be derived from the Medical Benefits Schedule (MBS) or Relative Value Guide. The Commonwealth Medical Benefits Schedule reflects the amount the government is prepared to reimburse people for medical services. It does not reflect the true value of the service. The graph above shows what the level anaesthesia rebate would be if it were indexed to CPI. This is reflected in the AMA suggested unit rate of $100.00 (accurate as of July 2024). All citizens are reimbursed up to 75% of the MBS unit value ($22.55), for anaesthesia services in private hospitals. Health insurance funds usually cover the other 25% but this still leaves a gap. Some insurance funds cover part of this gap but the amount varies depending on the fund.
Who to contact if I have questions or concerns?
- Call the Victorian Anaesthetic Group on (03) 8573 3500.
- Download the Billing information sheet PDF from the Australian Society of Anaesthetists website, which you can access directly via this link.
- You can contact the Commonwealth Ombudsman if you wish to make a complaint about your health insurance: https://www.ombudsman.gov.au/complaints/private-health-insurance-complaints
