FAQ for Patients
"Why have I been asked to contact ProBills Australia?"
"How can I request a patient's fee estimate from ProBills Australia?"
"Why does ProBills Australia appear on my credit card statement as a merchant?"
"How do I pay my account?"
"Why does my doctor charge me a gap?"
"What is the schedule fee?"
"What is the 'No Gap' scheme?"
"What is a 'Known Gap' account?"
"What is ProBills Australia's Privacy Statement?"
Why have I been asked to contact ProBills Australia?
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As part of our service to our clients we provide a fee estimate service. This allows patients to find out how much their anaesthetic bill is going to be, before they go into hospital. In many cases the only way we can do that is ring patients, and if they are not home, ask them to call back so we can provide them with this important financial information. If you have received a message to ring us, please do so on our Free Call 1800 673 118 number at your earliest convenience.
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How can I request a patient's fee estimate from ProBills Australia?
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We now offer an online fee estimate request service. Click here to request your fee estimate from ProBills Australia today. You can also call us on Free Call 1800 673 118.
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Why does ProBills Australia appear on my credit card statement as a merchant?
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ProBills Australia processes invoices for a large number of doctors (primarily anaesthetists) from all over Australia, and when patients pay by credit card, the payment goes through our merchant facility, so the payment is made to us. We then pass the money on to our client. The charge you have found on your statement will relate to a medical service you have made a payment for recently.
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How do I pay my account?
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Preferred Method:
Pay your account first. See the 'Payment Options" Section below. Then wait for our receipt so you can claim from Medicare and your private health fund if you are covered by health insurance. If you have not received a receipt from us within a week of making any payment, please ring our office for a copy.
Alternative Method:
Lodge the account with Medicare first. Between 4 to 6 weeks after you lodge your account with them, they will mail you a cheque made out to your doctor. If you have private health insurance, take the statement you receive from Medicare to your health fund. In due course they will also mail you a cheque drawn in favour of your doctor. Once you have received the cheques, forward them, along with any additional payment required from you to cover the fee, to P.O. Box 304, Mawson ACT 2607. See 'Payment Options' below for advice on how to make payments.
PAYMENT OPTIONS:
1. Cheques/Money Orders:
Make out cheques and money orders to the doctor shown at the top left hand side of your account and mail to P.O. Box 304, Mawson ACT 2607.
2. Internet EFT transfers:
We can accept EFT payments from you, providing you follow the guidelines listed below. To make an EFT transfer, use the following bank account as the recipient of your payment:
Account Name: ProBills Australia PTY LTD
BSB: 012 941
Account Number: 907136432
NOTE: This is NOT via BPay. It is a private EFT transfer, so it is essential that you include the unique EFT ID number as part of the details on your transaction, otherwise we may not be able to correctly allocate your payment against your account. The EFT ID number is clearly identified on your account and will look something like this: 'Brown4388Smith' where 'Brown is the surname of your doctor and 'Smith' is your surname (or the first part of it if a longer name).
3. Credit Cards (VISA and MasterCard only):
Your invoice provides you with the ability to send us a credit card payment by mail. Alternatively, you can ring through a payment by calling on FreeCall 1800 673 118.
NOTE: A 1.2% processing fee will be added to the fee if paying via VISA or MasterCard. This is not part of the medical fee charged by your doctor. It is levied by ProBills Australia to cover use of our credit card facility.
4. International Telegraphic Transfer:
For payment of accounts made from outside Australia. Please use the following details:
Bank Name & Branch: ANZ Bank, Woden
SWIFT Code: ANZBAU3M
Bank & Branch Number: 012-941
Account Number: 907136432
NOTE: Please ensure email remittance advice for your telegraphic transfer is sent to probills@ozemail.com.au so that we may identify the payment.
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Why does my doctor charge me a gap?
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Medical fees for private medical services are prepared using the Medicare Medical Benefits Schedule (MBS) and the Relative Value Guides (RVG) published by the Australian Medical Association and the Australian Society of Anaesthetists as a guide.
For surgeons, surgical assistants and physicians, the fees charged are based specifically on a set of item numbers directly related to the surgery and/or consultations performed.
For intensive care specialists, the fees charged are based item numbers related to specific ICU services provided to the patient whilst in an Intensive Care unit (including the placement and monitoring of pressure lines, pain management, management of ventilation etc).
For anaesthetic accounts, in addition to the item numbers for consultations and the base anaesthetic service, provision is made for the inclusion of additional item numbers to cover the duration of the anaesthetic service and factors that may impact on risks associated with anaesthesia. These can include the age of a patient, the patient's physical status, other anaesthesia related services (such as post operative pain management, transfusions, pressure monitoring etc) that are required to provide the highest standard of care and safety for the patient's anaesthesia and surgery.
Patients receive a rebate from Medicare, and their health fund if they are covered by private health insurance; however, these rebates do not cover the true cost of the anaesthetic service and associated practice costs. This may result in the need for patients to contribute an additional gap payment to cover the cost of the service.
Each doctor is required by law to determine what he or she believes to be a reasonable fee for the service they provide their patients. There are many reasons why a doctor charges a gap over and above what Medicare and the health funds subsidise via the Medicare Schedule Fee. The graph below shows the relative increases in the Consumer Price Index (CPI), Average Weekly Earnings (AWE), and the Medicare Benefits Schedule (MBS) since 1985.
It is clear from this graph that since 1985 AWE has increased by over two and a half times and the CPI has more than doubled, while the MBS has only increased on by just over one and a half times.
The practice costs incurred by your doctor follow the CPI increases, so as the years have passed there has been a increasing gap between what he/she has to pay in costs, and the remuneration he/she receives via the MBS. This leaves them little choice but to charge a gap to patients in order to maintain a reasonable relationship between income and costs. For the financial year ending 2009 the increase in the CPI for the health sector was 4.7%. The increase in the MBS for that period was just over 2%. Clearly unless there is a change in policy on matching MBS to corresponding increases in CPI it is likely that gaps for medical fees will continue and will have to increase over time.
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What is the schedule fee?
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For individuals eligible for Medicare benefits being treated as private patients within the Australian medical system, the Federal Government makes provision for patients to have the fees they incur as a result of treatment by doctors subsidised by the Medicare Benefits Schedule (MBS).
For each approved service (identified by an item number), the Federal Government lists a Schedule Fee. Medicare will pay a portion of the Schedule Fee. For outpatient services (which the private health funds are not allowed to subsidise), the Medicare rebate is 85% of the Schedule Fee. For in-patient services the Medicare rebate is 75% of the Schedule Fee; private health funds are allowed to subsidise the remaining 25%.
There is no suggestion by the Federal Government that the Schedule Fee reflects the true and proper value of the service provided, it is simply the amount they are prepared to offset. To put things in perspective, for anaesthetic accounts, which use units to arrive at a fee, in 2010 the Schedule Fee for one anaesthetic unit is $18.70. The Australian Society of Anaesthetists (ASA) and the Australian Medical Association (AMA) have both identified $69.00 as being the reasonable upper limit of fees for one anaesthetic unit. Similar discrepancies exist between the Schedule Fee and the AMA List of Fees for other medical services (although for most other specialist services the discrepancy is not as large). As the discrepancy for anaesthetic services is particularly large, most patients end up having to pay a gap.
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What is the 'No Gap' scheme?
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In 2001, the Federal Government introduced the No Gap scheme. Under this scheme the amount the health funds could contribute towards inpatient services was increased above the 25% allocated under the Schedule Fee, on the condition that the doctor accepted the resulting amount as full payment for their service. In this situation the doctor would bill the patient's health fund directly, which means that the patient would not receive a bill, and would incur no out-of-pocket expense. In 2010 the average rebate for 1 anaesthetic unit under the various health fund No Gap schemes rounds out at just on $31.00 per unit. For a patient to have access to this scheme their doctor has to be registered with the appropriate health fund however, doctors registered with the scheme have discretion as to which patients they bill under this arrangement.
As the No Gap rebates for anaesthesia remain significantly less than the ASA/AMA recommended level (and also proportionally poor compared to those offered to other specialists), it is not viable for all patients to be billed under these schemes, and so gaps remain for many patients.
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What is a 'Known Gap' account?
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In 2002 the Federal Government relaxed the regulations governing the payment of the No Gap rebate such that patients could obtain access to the No Gap level of fee subsidy, even though their doctor had charged a fee higher than the No Gap amount, and resulted in the patient receiving an account with an out-of-pocket expense component, provided the patient had been provided with a fee estimate prior to surgery. Ideally this would be in written form, and the patient would be required to provide the doctor with written confirmation that they had been provided with an estimate. In reality it is often the case that it is not possible to provide an estimate prior to surgery (for example, when surgery is an emergency procedure, or if the patient is booked for surgery at short notice) so there is a consensus that so long as a patient is provided with an estimate at the earliest possible point in time after the surgery then they will qualify for cover under this scheme. This is why it is important that if you, as a patient, have been asked to contact us for a fee estimate you should, because it could have a significant impact on what you have to pay out of your own pocket.
Health funds are not compelled to offer a Known Gap Scheme. Of the major health funds only Medibank Private, St Lukes and the AHSA funds are participants. HCF, MBF, NIB, AXA/BUPA/HBA, and Manchester Unity do not afford their members access to this scheme. If you are a member of this latter group of funds, and your doctor charges a gap you will receive a total reimbursement set at the Medicare Schedule Fee, rather than at the rebate level sanctioned under the Known Gap provisions.
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What is ProBills Australia's Privacy Statement?
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Privacy Statement:
ProBills Australia has been retained to manage all account matters pertaining to the medical services provided to patients by our client doctors. In order for us to do this we need to collect and store personal and medical information relating to the patient receiving the service. Information collected includes only that necessary to prepare this Invoice correctly. ProBills Australia guarantees that all reasonable precautions have been taken to limit access of the information to ProBills Australia employees only. In circumstances where ProBills Australia needs to communicate information to a third party, only that information critical to the third party's task is provided to them.
Should you wish to discuss any aspect of this Privacy Statement, please telephone ProBills Australia on FreeCall 1800 673 118, and ask for Phil Weber. For all account enquiries please contact ProBills Australia.
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