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Fees and billing

Most procedures Dr Martin performs in a private hospital are billed with no gap through the major health funds, provided your policy covers pain procedures. Consultations and clinic-based procedures are billed privately, with a Medicare rebate where applicable and a gap payable. A fee schedule is supplied on booking, prior to your consultation.

Will I pay a gap for a procedure in hospital?

In most cases, no. Dr Martin participates in no-gap arrangements with all major private health funds for procedures performed in a private hospital. If your hospital cover includes pain management procedures — generally Bronze-tier hospital cover or above — his fee for the procedure is billed directly to Medicare and your fund, with no gap payment for the procedure itself.

Two things sit outside this arrangement and are worth checking with your fund before admission:

• Hospital fees are generally covered by private health insurance, but your policy's excess may apply to your first admission of the year, depending on your fund and policy — check with your health fund before admission.
• The anaesthetist bills separately. Dr Martin works with anaesthetists who also participate in no-gap arrangements, except in exceptional circumstances where a no-gap anaesthetist is not available — in which case this is discussed with you before your procedure.

If you are unsure what your policy covers, call your fund and ask whether it covers pain management procedures in a private hospital. The practice can provide the relevant item numbers for you to quote.

Which hospitals are procedures performed at?

Procedures are performed at Hollywood Private Hospital, St John of God Subiaco Hospital and the Mount Hospital. Most procedures can be offered at any of these; a small number are performed only at a particular hospital because of the staffing or equipment they require, and this is confirmed with you when the procedure is booked.

What does a consultation cost?

Consultations at the Mount Lawley rooms are billed privately. With a valid referral, a Medicare rebate applies to eligible consultations, reducing your out-of-pocket cost — a gap applies. A fee schedule covering the fee, the rebate and the expected gap is supplied on booking, prior to your consultation.

What about clinic-based procedures?

Some procedures are performed in the rooms rather than in hospital. Clinic-based procedures are charged privately and will incur a gap. A Medicare rebate applies where an item number exists, but — unlike procedures performed in hospital — clinic procedures are not covered by health-fund no-gap arrangements. A fee schedule is supplied on booking, prior to your consultation.

Which treatments are not covered by Medicare or health funds?

A small number of treatments have no Medicare item number. These are excluded from no-gap arrangements and from Medicare rebates, and are an out-of-pocket cost. They include platelet-rich plasma (PRP) injections and hyaluronic acid injections, and certain other non-rebated treatments. Where a non-rebated treatment is an option for you, the cost is set out in writing before you decide whether to proceed — and Dr Martin will give you a plain assessment of whether he thinks it is likely to be worth it in your case.

Do I need a referral?

Yes — both to be seen and to claim a Medicare rebate on specialist consultations. A referral from your GP is valid for 12 months; a referral from another specialist is valid for 3 months. Referrals are accepted by Healthlink (EDI: painmdwa), fax (08 6114 0717) or email (admin@painmedicinewa.com).

Compensable and funded schemes

The practice accepts patients under WorkCover WA, the Insurance Commission of Western Australia (ICWA) — including but not limited to motor vehicle injury claims — and DVA.

If your care is under a WorkCover WA or ICWA claim, please tell the practice when you book. Pre-approved funding must be confirmed with your insurer before your appointment. Approval generally takes around two weeks and can take longer, so mention your claim as early as possible and have your claim number and case manager details ready. If a claim is not disclosed until the day of the appointment, payment in full is required on the day, with reimbursement then sought from your insurer.

DVA patients should provide their card details at booking.

The practice does not see patients under NDIS funding arrangements.

How and when do I pay?

Payment is expected at the time of consultation, by EFTPOS, debit or credit card. Cash is accepted, but change cannot be given, so please bring the exact amount. Medicare rebates are processed for you where applicable.

If you cannot attend an appointment, please call at least one full working day ahead — a fee may apply where less than 24 hours' notice is given.

How do I find out what I will pay?

A fee schedule is supplied on booking, prior to your consultation. If anything is unclear, call the rooms on 0448 299 260 during clinic hours (Monday 9:00am–4:00pm, Tuesday to Thursday 8:00am–4:00pm) and the practice secretary will talk you through it.

This page provides general information about billing at Pain Medicine WA. Fees are confirmed individually in writing before your appointment. In an emergency call 000.

Reviewed by Dr Chris Martin, Consultant Pain and Rehabilitation Physician.