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Appointment Information
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Mixed Billing and GAP fee appointments and Procedures
From the 1st of July 2022 Optimal Health Medical Centre will transition towards a mixed billing practice and an out of pocket (Gap) fee for most procedures and some consultation slots will apply.
MOST consultation appointments will still be BULK BILLED for ALL Medicare Card holders.
Only a small number of GAP fee appointment slots will be introduced for each doctor each day that can only be booked through reception. The rest of the appointment slots will still be Bulk billed for all Medicare card holders.
We hope the below information helps you understand the changes to our billing policy.
Why is a GAP fee being introduced to some appointments?
Medicare is a public health insurance scheme and the rebates it provides to you are only intended to be a subsidy toward the payment of your health and doesn’t cover the total cost of the health service provided when you access eligible health care services, such as visiting your GP. We value our patients as well as our doctors and under the recommendations of the RACGP and the AMA, as a practice we have made the difficult decision to move to mixed billing to ensure that, our practice continues to attract and retain the very best Specialist General Practitioners and maintain a high-quality service for all our patients that is both thorough and safe now and, in the years, to come. In addition, to being able to sustain high levels of health care, mixed billing will indicate to the government that an increase in your Medicare rebate is necessary to cover the cost of high-quality healthcare.
What does “Mixed” billing mean for our practice and how does it apply to you?
Mixed billing is referred to when an out of pocket (Gap) fee applies to consultations and procedures.
As we try to maintain equitable and accessible healthcare at Optimal Health, only a small number of GAP fee appointment slots will be introduced for each doctor each day. The rest of the appointment slots will still be Bulk billed for all Medicare card holders.
For GAP fee appointment – DVA Card Holders, Pensioner Concession Card Holders, Children under 16, Health Care Concession Card Holders and Seniors Card Holders are charged a discounted gap fee at half of the standard GAP.
When a Gap fee is applicable to your appointment, and you hold a Medicare Card you will be eligible to receive the Medicare Rebate as a subsidy towards the cost of your consultation or procedure.
Will I know the cost of my appointment before I come in?
Our reception staff will always try to give you the most accurate advice possible about the likely costs of your appointment ahead of time. However, please keep in mind that the reception staff will only be able to offer you advice based on the information you provide and that your type of consultation may change once you’re in with the doctor based on your needs. Key indicators that will change the cost of your appointment include the length (time) of your appointment, how many issues you discuss with the doctor, and whether there is a procedure involved in your appointment. We have tried our best to keep the gap payment as consistent as possible across all appointment types so that patients do not experience too much variation.
When could bulk-billing still apply?
Access to healthcare is very important to us. Therefore, only a small number of GAP fee appointments will be introduced for each doctor each day. The rest of the appointment slots will still be Bulk billed for all Medicare card holders. We at Optimal Health will be making bulk billing appointment slots available for as long as it can be sustained.
Gap Fees – how do they work?
The total cost of your appointment will depend on the amount of time spent with the GP. If the time required to discuss your medical issues is longer than a standard appointment, a long consult will be
charged. Your out-of-pocket expense however will remain the same, Just the upfront payment will be higher.
The payment process works as follows; You pay the total amount (as outlined in the total fee column). We then process your Medicare rebate (this is the money that you can claim back from Medicare). This is done immediately onto a physical debit card. We are unable to process rebates for mobile phone tap-and-pay and credit cards, If you do not have a physical debit card, you will be provided a receipt for which you can make the claim online or we are able to submit the claim online for you as long as you have current bank details lodged with Medicare.
Why do we charge the full fee and not just the gap amount?
Current legislation makes it illegal to charge a gap fee only. We must ask for the payment of the full fee at the time of the consultation. If you are eligible for a Medicare rebate, the full rebate amount will be processed at the practice at the time of payment. If you do not have a physical debit card, you will be provided a receipt for which you can make the claim online or we are able to submit the claim online for you as long as you have current bank details lodged with Medicare. Please ensure your current bank account details are lodged with Medicare.
Will my phone/video consultation booked into a GAP fee slot incur an out of pocket fee?
Yes – for GAP fee appointment slots that are booked as telehealth.
No- For telehealth appointments booked into bulk billing slots, there will be no gap to pay in this circumstance.
You will be able to make payment over the phone with reception or we can send you a secure link via Medipass that will allow you to enter payment details online (with the payment processed after the consultation has been completed). We can then submit your Medicare rebate claim online on your behalf, this is then deposited into your bank account by Medicare within 2-3 business days.
Fees List
GAP FEE APPOINTMENT SLOTS
Commencing 1st July 2022
| Standard Consultation Fee Information
Weekdays and Saturday before 1pm |
|||
| Service Items | Our Fee | Your Medicare Rebate | Gap |
| Short Consultation
(Item 23) < 20 Minutes |
$59.75 | $39.75 | $20.00 |
| Long Consultation
(Item 36) <40 Minutes |
$96.95 | $76.95 | $20.00 |
| Prolonged Consultation
(Item 44) ≥ 40 Minutes |
$133.30 | $113.30 | $20.00 |
| Mental Health Care plan
(Item 2715) |
$106.25 | $96.25 | $20.00 |
| Standard Consultation Fee Information
Saturday from 1pm & All-day Sunday |
|||
| Service Items | Our Fee | Your Medicare Rebate | Gap |
| Short Consultation
(Item 5020) < 20 Minutes |
$71.80 | $51.80 | $20.00 |
| Long Consultation
(Item 5040) <40 Minutes |
$108.80 | $88.80 | $20.00 |
| Prolonged Consultation
(Item 5060) ≥ 40 Minutes |
$144.50 | $124.50 | $20.00 |
| Mental Health Care plan (Item 2715) | $106.25 | $96.25 | $20.00 |
*DVA Card Holders, Pensioner Concession Card Holders, Children under 16, Health Care Concession Card Holders and Seniors Card Holders are charged a discounted gap fee of $10.
PROCEDURE FEES – 1st July 2022
| PROCEDURE | ITEM NUMBER | TOTAL AMOUNT | MEDICARE REBATE | GAP |
| Wound Care*
(At doctors’ discretion) |
23
36 |
49.75
86.95 |
39.75
76.95 |
10.00
10.00 |
| Mirena Insertion | 35503 | 165.00 | 84.75 | 80.25 |
| Mirena Removal | 23
36 |
69.75
106.95 |
39.75
76.95 |
30.00
30.00 |
| Implanon Insertion | 14206 | 57.65 | 37.65 | 20.00 |
| Implanon Removal | 30062 | 94.20 | 64.20 | 30.00 |
| Iron Infusion | 36 | 106.95 | 76.95 | 30.00 |
| Skin Biopsies | 30071 | 85.20 | 55.20 | 30.00 |
| Skin lesion excisions | Varies | 80-300 | Varies | 30.00 |
Appointments
Please book an appointment via our website or call 02 4647 1133.
Every effort will be made to accommodate your preferred time and doctor. Emergencies will always be given priority and our reception staff will attempt to contact you if there is any unforeseen delay or your GP has been called away. Longer consultation times are available, so please ask our receptionists if you require some extra time. Examples of longer appointments would be; new patients, pap smears, immunisations, mental health consultations and excisions.
Interpretation Services
If you or a family member requires an interpreter service, we can organise this for you. Please let us know when you book an appointment.
Fees and billing arrangements
For patients with a valid Medicare card, most consultations are bulk billed.
For workers compensation or motor vehicle third party matters, we require your claim number to bill the relevant insurance companies.
For fees regarding Allied Health professionals, procedures and other treatments please enquire at reception or give us a call.
Any additional charges will be discussed prior to the consultation/procedure.
Care outside normal opening hours
Optimal Health Medical Centre provides care up to 8pm. For medical attention after these hours please contact 13SICK (13 7425). Or contact the after-hours GP helpline on 1800 022 222.
Telephone access
Phone calls from patients are generally not taken by the doctors during a consult due to confidentiality reasons. However, for certain circumstances, patients may leave a phone message and where appropriate the doctor will return the call within 24 hours. If the matter is urgent, the doctor will take the call. If in an emergency, please call 000.
Getting the results of any test or procedure
For purposes of privacy, accuracy and confidentiality as well as medico-legal reasons, pathology and imaging results will NOT be given over the phone nor be given to any third party unless prior arrangements have been made between the doctor and patient. Please book to see your doctor or the next available doctor to discuss them.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_single_image image=”243″ img_size=”full”][/vc_column][/vc_row]