Fees & Billing
Our commitment to clarity
Considering orthopaedic surgery is a significant decision — personally, physically, and financially. At Ortho Precision, we believe that every patient deserves to feel fully informed about the cost of their care before making any commitment.
Before surgery is booked, you will be given a clear, written estimate that sets out Dr Edirisinghe's fee, along with guidance on the hospital and anaesthetist components. Our rooms team is happy to walk you through every line item in plain language and answer any question you may have — no matter how small it may seem.
With experience at major public hospitals in Sydney and Newcastle, Dr Edirisinghe treats various orthopaedic conditions and excels in treating complex orthopaedic joint replacement surgery. Beyond surgical excellence, Dr Edirisinghe is the director of surgeon training for the Australian Orthopaedic Association in the training of new surgeons. He also offers workshops for teaching new surgeons about joint replacement technology and complex trauma management. This allows Dr Edirisinghe to remain at the forefront of orthopaedic care and advancements.
Understanding the language of medical billing
Medical billing in Australia can involve terminology that is not always intuitive. The short glossary below explains the words you are most likely to encounter during your treatment journey.
Medicare rebate — A partial refund from Medicare for medical services listed on the Medicare Benefits Schedule (MBS). A current referral is required to claim any rebate.
Private health insurance benefit — A further contribution from your private health fund toward the surgeon's fee, the anaesthetist's fee, and your hospital stay.
Out-of-pocket cost — The amount you pay yourself after Medicare and (if applicable) your health fund have paid their portions.
Gap — The difference between the total fee charged for a service and the combined amount Medicare and your health fund will pay. The "gap" is the portion that comes out of your own pocket.
No gap — A billing arrangement in which the surgeon's fee is fully covered by the combined Medicare and health-fund contributions, so there is no out-of-pocket surgical fee for you. Whether a "no gap" outcome is available depends on your fund, your policy, and the procedure.
Known gap — A billing arrangement in which a capped out-of-pocket amount is agreed in advance, so you know exactly what your maximum out-of-pocket cost will be before surgery is booked.
Self-funded surgery — Surgery paid for by the patient directly rather than through a private health insurance policy.
Your initial consultation
Referrals
To see Dr Edirisinghe and claim a Medicare rebate for your consultation, you will need a current referral:
- from your general practitioner (valid for 12 months), or
- from another specialist (valid for 3 months).
Referrals from allied health practitioners — for example, physiotherapists — do not attract a Medicare rebate.
Consultation fees
Consultation fees are payable on the day of your appointment. Our reception team will process your Medicare rebate on the spot, with the rebate deposited directly into your nominated bank account, usually within a few days.
Our rooms accept payment by EFTPOS, Visa, Mastercard, and bank transfer.
Telehealth
Where clinically appropriate, Dr Edirisinghe offers telehealth consultations for selected initial and follow-up appointments. Please let our team know at the time of booking if you would prefer a telehealth appointment.
How surgical fees are structured
When you have surgery, several separate fees are usually involved. Each is billed by the party that provides that specific service.
- Surgeon's fee — Dr Edirisinghe's professional fee for performing your operation, and, where required, the fee of a surgical assistant.
- Anaesthetist's fee — charged separately by your anaesthetist. Anaesthetists set their own fees and gap arrangements independently of our practice.
- Hospital fees — covering accommodation, nursing care, operating theatre, and ward services. These are billed to you separately by the hospital.
- Prosthesis or implant charges — for joint replacement and some reconstructive procedures, the device used (such as a hip or knee implant) is billed by the hospital. For most privately insured patients, implant charges are covered in full by the health fund.
- Imaging and pathology — any scans, X-rays, or pathology tests required before or after surgery are billed separately by the providers that perform them.
A detailed written estimate covering Dr Edirisinghe's fee will be provided before you confirm a date for surgery. If you would like a complete picture of the total cost, our team is happy to help you contact the hospital and your anaesthetist for their components as well.
Fees if you have private health insurance
The out-of-pocket cost for patients with private health insurance depends on:
- your level of cover and any applicable waiting periods,
- whether your fund has a gap-cover agreement with your surgeon and anaesthetist,
- which version of the gap-cover scheme your fund uses, and
- the specific procedure that is being performed.
Honouring your fund's gap arrangements
Wherever possible, Dr Edirisinghe participates in the gap-cover arrangements of your private health fund. In practice, this means your surgical fee is structured so that — subject to your fund's rules — your out-of-pocket cost for Dr Edirisinghe's fee is kept to either:
- no gap (nil out-of-pocket for the surgeon's fee), or
- a known gap (a capped, pre-agreed out-of-pocket amount).
For some health funds, a no-gap outcome applies as a matter of course. For certain procedures, a no-gap outcome applies regardless of fund. Our team will confirm exactly which arrangement applies to you, in writing, before your surgery is booked.
Continuing care for returning patients
Many of our patients come back to Dr Edirisinghe for further orthopaedic care over time — for example, a procedure on the other knee, a hip replacement after a previous knee replacement, or surgery on another joint altogether. For subsequent procedures of this kind, the surgeon's fee is often billed with no out-of-pocket cost to you. It is our way of acknowledging the ongoing trust that returning patients place in our practice.
Please note that subsequent procedures may still involve fees from the anaesthetist and the hospital, which are set independently of our practice.
Self-funded surgery
If you do not hold private health insurance, or if your current policy does not cover the procedure you need, you may still access surgery at a private hospital on a self-funded basis. Self-funded surgery allows you to have your procedure at a time that suits you, at the hospital of your choice, and under the care of Dr Edirisinghe.
When you choose to self-fund:
- You will receive a detailed written estimate covering the surgeon's fee, along with guidance on the anaesthetist and hospital components.
- The surgeon's fee is payable in full prior to your date of surgery.
- The hospital and anaesthetist will invoice you separately under their own payment terms.
- A Medicare rebate may still apply to part of the surgeon's, assistant's, and anaesthetist's fees.
Our team will take the time to walk you through every element of your estimate and answer your questions before you decide to proceed.
Using your superannuation to fund medical treatment
Some patients choose to fund their procedure by applying for early release of superannuation on compassionate grounds. This is a pathway administered entirely by the Australian Taxation Office (ATO), not by our practice.
How we can help
If you decide to explore this option, our rooms can support you in two practical ways:
- Where it is clinically appropriate, Dr Edirisinghe can complete the specialist medical practitioner's report required by the ATO (currently form NAT 74927).
- Written quote. We will provide a detailed written quote for your procedure, which the ATO may ask to see as part of your application.
We are not a financial adviser and we cannot assess your eligibility for early release. Before deciding to access your super, we encourage you to speak with your accountant, financial adviser, or superannuation fund about the long-term implications of early withdrawal. Eligibility is determined solely by the ATO.
Further information is available from the Australian Taxation Office at ato.gov.au under "early access to super — compassionate grounds".
Payment policy
- Consultations are payable on the day of your appointment.
- Surgical fees are payable in full prior to your date of admission.
- Hospitals and anaesthetists will send their own separate invoices and payment terms.
- We accept EFTPOS, Visa, Mastercard, and bank transfer. American Express may attract a surcharge.
Changes and cancellations
We understand that life does not always follow the plan. If you need to reschedule or cancel your surgery, please contact our rooms as early as possible so that the theatre time can be offered to another patient who needs it. Fees paid in advance will be refunded in accordance with the written terms that accompany your surgical estimate.
We are here to help
Every patient's circumstances are different, and we know that the financial side of surgery can feel overwhelming. If anything on this page is unclear, or you simply want to talk it through, please contact our rooms. Our team will take the time to explain your written estimate in plain language and help you make a decision that is right for you.
This page provides general information only. All figures discussed with the practice are provided as written estimates based on your specific circumstances and are subject to change in line with your private health fund's rules, Medicare Benefits Schedule items, and clinical requirements at the time of surgery.
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