An Explanation of Fees
The standard fees charged by our rooms are in line with the Australian Medical Association recommended fee schedule. This means that in most instances there will be a ‘gap’ between our surgical fee and what is covered by Medicare and your health insurance fund.
If there is any problem with this it is important that you ask about this gap. Our staff are fully informed with charges and rebates and will be able to help you navigate through what can be a complex process. These fee explanations can cover:
- Consulting Fee
- Surgical Fee
- Treatment Estimates
If you require more information, please do not hesitate to call the practice during office hours.
Other Possible Disbursements
There may be other charges involved in your care depending on which course of action you choose. You need to also check with your health fund to see what is covered for additional areas of service. Potential areas of cover are:
- Hospital
- Surgical Assistants
- Implants or Prosthesis
- Anaesthetics
- Tests (Radiology, Pathology)
- Post-Operative Care
Estimates
We offer informed financial consent to all our patients prior to surgery. This is a pre-treatment estimate of your surgical costs. This estimate enables you to discuss with your health insurance company what you are covered for and if benefits are applicable.
Private Patients
Overview
If you choose to be treated as a private patient, you will be treated at hospitals that our doctor is affiliated to or is a visiting medical specialist. After discharge, your care will be carried out in either an outpatient clinic or in my private rooms, or will be referred to your local general practitioner.
Types of Private Patients
This practice caters for a range of Private patients, these include:
- Private Health Insured
- Department of Veterans Affairs (DVA)
- WorkCover
- Self-Insured (Uninsured)
- Overseas Patients for Hospital Cover
Private Health Insurance
Private Health Insurance allows you to access inpatient health services at the right time. You have control of your health care and can choose the provider, facility and timing of your treatment. 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.
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 in understanding the costs involved in your care.
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.
Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated.
Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with the AMA fee schedule.
You should be aware that 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.
Your Private Health Fund along with Medicare cover part of the cost of your surgery. You are responsible for paying the fees relating to your surgery, an estimate of which will be provided to you in the form of an Informed Financial Consent. We are able to bill many health funds directly for surgery, however as some funds do not adequately compensate for all procedures this may mean that you will be required to prepay for your procedure and claim back from Medicare and your Private Health Fund post-operatively.
In the case that prepayment is required, at your post-operative appointment we will provide you with a Medicare Two-Way Claim Form and your itemised invoice. Complete the form and submit your invoice and form together to Medicare via options provided on form (online, in person, or via post).
You do not need to do anything else to claim your rebates as Medicare will process your rebate in to the bank details you have provided them and forward the invoice to your Private Health Fund who will process their portion of the rebate owing to you. Rebates equate to 100% of the MBS Schedule fee.
Please note that you are also responsible for paying the balance of fees, also known as “out-of-pocket costs” (OOP) as listed on your Informed Financial Consent. These out-of-pocket costs are not claimable through Medicare or Private Health Insurance as these fees are above what Medicare and your Private Health Fund cover.
Department of Veterans Affairs (DVA)
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 (including 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
WorkCover
If you are injured at work and need medical treatment or time off work, you may be eligible for compensation which may include time off work and treatment expenses.
You can find information regarding making a WorkCover claim in Victoria here www.worksafe.vic.gov.au/you-make-workcover-claim
If your doctor or specialist has given you a referral to Mr Toshniwal the process for WorkCover patients is roughly as follows:
Call our rooms to arrange an initial consultation with Mr Sumeet Toshniwal, General Surgeon
We will send you a HotDoc link to complete our Registration Form
Once your WorkCover claim is approved you must provide the following to our rooms as soon as possible, preferably prior to your initial consultation:
- a copy of the approval letter in pdf format
- your claim number
- date of injury
- employer's name, address, contact details + details of WorkCover officer/contact person including full name, phone, fax, email
- Workcover Claim Manager's details including full name, phone, fax, email
Once you have consulted with Mr Toshniwal and he has recommended surgery, we need the above information before we can move forward.
Once this information is received, we will send a letter of "request for surgery approval" to your WorkCover insurer. They will review this request and this process can take 28 days before they advise whether they will approve or reject the surgery approval request.
You can find more information here
Once surgery approval has been granted by your WorkCover insurer we can schedule your surgery. Your surgery can usually be scheduled within 1-2 weeks from this time.
Please also see information regarding fees below.
Self-Insured (Uninsured)
Patients may choose private admission even if they do not have private health insurance. Self-funded patients will be liable to pay the following:
- Specialist’s fee (we will process any applicable Medicare rebate to Medicare on your behalf after your surgery)
- Anaesthetist’s fees
- Assistant Surgeon’s fees
- Hospital accommodation fees (bed charge)
- Surgically implanted prostheses (usually included within hospital fees estimate)
- The gap for diagnostic services (medical imaging and laboratory), however some of these services may be bulk billed to Medicare, that is no ‘gap’
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, please contact our rooms.
Please note that we are unable to give fees estimates until after consultation with Mr Toshniwal as we must submit a fees estimate request to the hospital and this takes on average 7-10 business days to receive back. Please email our rooms if you have not received your Fees Estimate by a fortnight following your initial consultation so that we can follow this up for you.
Overseas Patients
No 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. You may be able to claim a portion of these fees back from your Overseas Private Health Insurance which is mandatory for all overseas visitors, overseas students, and temporary residents. It is your responsibility to ensure that your level of Private Health Insurance will cover you for the surgery required prior to surgery, otherwise full private fees apply.
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.
Private vs Public Fees
You may choose to be a public or a private patient. This page provides patients with the different options for surgery in the private or public hospital systems.
Private Hospital Treatment:
In the private system, your surgery will be performed by Mr Sumeet Toshniwal himself who will also provide your follow up care whilst an inpatient and following this as an outpatient in his rooms. You have a choice with regards to when your surgery is booked, and this can usually be booked for you within 1-2 weeks from consultation. Please also refer to information on this page regarding Fees.
Public Hospital Patients:
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 usually performed by a registrar (doctor training in General Surgery) who is supervised by a senior 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 severity of your condition (usually minimum 12 months). Your follow up visits after surgery will be arranged through the hospital.
After consultation with Mr Sumeet Toshniwal you can elect to be referred to the public health waiting list with Eastern Health. Please note that you do not get to choose your surgeon, treating team, or date of surgery when electing to have surgery as a public patient.
Fees
Overview
Our administration team will be happy to advise you of the consultation fee upon booking an appointment. Payment on the day of consultation is required and we will process your Medicare rebate to Medicare on your behalf (if applicable).
- EFTPOS
- Credit Card: VISA, Mastercard, Amex
- Cash
- Bank cheque
- Bank transfer (please note due to the slow processing of bank transfer, payment must be made well in advance of surgery to avoid potential delays if choosing this payment option)
- Pay for the operation yourself (“Self-Funded”)
- For those with Medicare Mr Toshniwal can refer you to the Eastern Health Public Waiting List
- Provided it is not contraindicated to wait for surgery you can elect to take out Private Health Insurance and sit out the waiting period before scheduling surgery
- Completed application form – click here to download
- A letter of support from your General Practitioner
- A letter of support from our clinic (we will provide this after your initial consultation)
Tax Refund Scheme
Tax Rebate Scheme for Medical Expenses
A significant rebate can be claimed through your end of year tax return if you incur medical expenses over $2,000 during the one financial year. Anyone can claim the tax offset: there is no upper limit on the amount you can claim, however it is now income tested. The rebate is currently 20 cents for every dollar over the $2000 threshold.
There is no upper limit on the amount you can claim, and it is not means or assets tested. Because this is a rebate rather than a tax deduction, you can claim this from the ATO even if you do not pay tax. As always, also check with your accountant or financial advisor.
Because this is a rebate rather than a tax deduction, you can claim this even if you do not pay tax. It is claimed at question T9 on your tax return. As always, be sure to check with your accountant or financial advisor. Further details can be found by clicking here
No Private Health Insurance
If you do not have Private Health Insurance and you need surgery, your options include:
- For those with Medicare Mr Toshniwal can refer you to the Eastern Health Public Waiting List
- Pay for the operation yourself (“Self-Funded”)
- Take out Private Health Insurance and wait 12 months to sit out initial waiting period before scheduling surgery
Mr Toshniwal is appointed at two Public Hospitals where he has regular operating lists.
The care in the public hospital is free of charge to you.
Waiting List
However, the Waiting List for operations in the Public system is considerable, currently upwards of twelve months and patients are admitted to hospital on a "first come, first served" basis.
Self-Insured
An increasing number of people are choosing to "Self-Insure" or pay for their own surgery, so they don't have to wait. This is often a worthwhile investment as it means you can have your operation done straight away or whenever it suits you. This can allow you to get back to your work and sport as soon as possible.
All the private hospital fees associated with your surgery are an out-of-pocket expense, but we will assist you in obtaining an estimate of costs from the private hospital before you go ahead with your surgical procedure.
Call my practice and they will be happy to provide you with an accurate costing. A proportion of my fees and the anaesthetic fees attract a small rebate from Medicare.
If you require more information, please do not hesitate to call us on during office hours.
Related Link Buttons
We would recommend the following links on each of the above pages.