Fees & billing

You’ll know exactly where you stand

Considering surgery is a significant decision — personally, physically and financially. Before anything is booked, you receive a clear written estimate of Dr Yas’s fee, with guidance on the separate hospital and anaesthetist components. No surprises, and every question answered — however small. Call our rooms any time on 08 7081 4100.

01

Our commitment to clarity

You should never feel unsure about the cost of your care. Before your surgery is booked, you will be given a clear, written estimate that sets out Dr Yas’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.

The principle is simple: you will know what applies to you, in writing, before you decide anything.

02

The language of medical billing

Medical billing in Australia uses terms that aren’t always intuitive. Here are the ones you’re most likely to meet.

Medicare rebate
A partial refund from Medicare for 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 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 and the combined amount Medicare and your fund will pay — 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 fund contributions. Whether it’s 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 your maximum cost before surgery is booked.
Self-funded surgery
Surgery paid for by the patient directly rather than through a private health insurance policy.
03

Your initial consultation

Referrals

To see Dr Yas and claim a Medicare rebate for your consultation, you’ll need a current referral — from your GP (valid 12 months) or another specialist (valid 3 months). Referrals from allied health practitioners, such as 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 usually deposited into your account within a few days. We accept EFTPOS, Visa, Mastercard and bank transfer. Our team will confirm the exact consultation fee when you book, so there are no surprises when you arrive.

Telehealth

Where clinically appropriate, Dr Yas offers telehealth for selected initial and follow-up appointments. Let our team know your preference when booking.

04

How surgical fees are structured

When you have surgery, several separate fees are usually involved. Each is billed by the party that provides that service.

1Surgeon’s fee — Dr Yas’s professional fee for performing your operation, and, where required, the fee of a surgical assistant.
2Anaesthetist’s fee — charged separately by your anaesthetist, who sets their own fees and gap arrangements independently of our practice.
3Hospital fees — accommodation, nursing, operating theatre and ward services, billed to you separately by the hospital.
4Prosthesis or implant charges — for joint replacement, the device is billed by the hospital. For most privately insured patients, implant charges are covered in full by the fund.
5Imaging and pathology — any scans, X-rays or tests are billed separately by the providers that perform them.

A detailed written estimate covering Dr Yas’s fee is provided before you confirm a surgery date. If you’d like a complete picture of the total cost, our team is happy to help you contact the hospital and your anaesthetist for their components too.

05

If you have private health insurance

Your out-of-pocket cost depends on your level of cover and any 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.

Honouring your fund’s gap arrangements

Wherever possible, Dr Yas participates in the gap-cover arrangements of your private health fund. Subject to your fund’s rules, this means your out-of-pocket cost for Dr Yas’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 amount).

Our team will confirm exactly which arrangement applies to you, in writing, before your surgery is booked.

We stand behind our work

Continuing care for returning patients

Many patients return to Dr Yas for further care over time — a procedure on the other knee, a hip after a previous knee, or another joint. For subsequent procedures of this kind, the surgeon’s fee is often billed with no out-of-pocket cost to you. It’s our way of acknowledging the trust returning patients place in the practice.

Subsequent procedures may still involve anaesthetist and hospital fees, which are set independently of our practice.

06

Self-funded surgery

If you don’t hold private health insurance, or your policy doesn’t cover the procedure you need, you may still access surgery at a private hospital on a self-funded basis — at a time that suits you, at the hospital of your choice, under Dr Yas’s care.

  • You’ll receive a detailed written estimate covering the surgeon’s fee, 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 invoice you separately under their own terms.
  • A Medicare rebate may still apply to part of the surgeon’s, assistant’s and anaesthetist’s fees.
07

Using your superannuation

Some patients choose to fund their procedure by applying for early release of superannuation on compassionate grounds. This pathway is administered entirely by the Australian Taxation Office (ATO), not by our practice, and eligibility is determined solely by the ATO.

How we can help

  • Where it’s clinically appropriate, Dr Yas can complete the specialist medical report the ATO requires (currently form NAT 74927).
  • We can provide the detailed written quote the ATO may ask to see as part of your application.

We are not financial advisers and cannot assess your eligibility. Before accessing your super, please speak with your accountant, financial adviser or super fund about the long-term implications. Further information is available from the ATO at ato.gov.au under “early access to super — compassionate grounds”.

08

Payment, changes & cancellations

  • Consultations are payable on the day of your appointment.
  • Surgical fees are payable in full prior to your date of admission.
  • Hospitals and anaesthetists 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

Life doesn’t always follow the plan. If you need to reschedule or cancel your surgery, please contact our rooms as early as possible so the theatre time can be offered to another patient who needs it. Fees paid in advance are refunded in accordance with the written terms that accompany your surgical estimate.

We’re here to help

Every patient’s circumstances are different, and the financial side of surgery can feel overwhelming. If anything here is unclear, or you simply want to talk it through, contact our rooms — we’ll explain your written estimate in plain language and help you make the right decision.

Request a consultation 08 7081 4100

This page provides general information only. All figures discussed with the practice are provided as written estimates based on your 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. Dr Yas Edirisinghe — FRACS, FAOrthA. Ahpra reg. MED0001219741.