Fees and health funds
Dr Tsung bills through the major funds' Known Gap schemes. For his surgical fee, that means a capped out-of-pocket cost you know in advance, not an open-ended bill. Before any surgery, you receive a written estimate of your expected costs.
What is Known Gap billing?
Known Gap means a single, capped amount you pay towards the surgical fee, agreed and disclosed in writing before surgery. Your fund pays the largest part of the fee; the Known Gap is the capped amount you pay on top. The exact figure is confirmed in your written estimate, so you know it before you decide.
How does Known Gap work?
Every operation has a Medicare Schedule fee, an amount set by the government and usually well below what surgery actually costs. Medicare pays part of that schedule fee and your health fund pays the rest. Because surgeons set their own fees, a surgeon's fee is normally higher than the schedule fee, and the difference is the gap.
Under a Known Gap arrangement, your fund pays more than the minimum it's required to. With Medicare, that covers the largest part of the fee, and you pay the capped Known Gap on top. There's nothing else to pay on the surgical fee.
Without that arrangement, your fund pays only its minimum. Medicare and your fund still cover the schedule fee, but you pay the whole difference between that and the surgeon's fee, and nothing caps it. A fee set independently, such as at the AMA's recommended rates, can sit well above the schedule fee, so that difference can be large, and you might not know it until the bill arrives. Billing through Known Gap is the fairer arrangement for you: your fund carries the larger share, and your cost is capped at a figure agreed up front.
What if I'm with nib?
Dr Tsung is a participating surgeon in nib's Clinical Partners program. If you're with nib and your hospital cover includes total hip or knee replacement and you've served any waiting periods, the program covers the procedure, including the hospital stay, the surgical team and the implant, so you pay only the excess on your policy and no gap on the surgical fee. Partial joint replacements, including unicompartmental (partial) knee replacement, aren't part of the program. nib confirms exactly what's covered before you book.
How much will my surgery cost?
Your total out-of-pocket cost depends on your health fund, your level of hospital cover, and the procedure. For that reason we don't quote a single price for everyone. Once Dr Tsung has assessed you and surgery is planned, your written estimate sets out the costs before you decide to go ahead. This is your informed financial consent, and we provide it in every case.
What other costs are involved?
The surgical fee is only one part of the total, and several costs are billed separately by other providers. Your written estimate from us covers the surgical fee; the others provide their own estimates on request.
- Hospital costs and policy excess. The hospital bills for your stay. If your policy carries an excess, you usually pay it on admission.
- Anaesthetist. Your anaesthetist bills separately for their part of the procedure.
- Surgical assistant. Where an assistant is needed, this is billed separately.
- The implant. For privately insured patients, the joint implant is covered by your fund under the prostheses arrangements. For self-funded patients, it is included in your estimate.
We can tell you who to contact for each part, so you can confirm the full picture before your surgery date. If you qualify under nib's Clinical Partners program (above), these are covered for your hip or knee replacement and you pay only your excess.
What if I don't have private health insurance?
You can still have surgery as a self-funded patient. On request we provide a written estimate of the surgical fee, and the hospital and anaesthetist can quote their parts, so you have the full cost before going ahead.
Will Medicare help with the cost?
Medicare provides a rebate on specialist consultation fees when you have a valid referral, and contributes to the surgical fee for eligible procedures. It does not cover hospital costs for private surgery, which is where your private health cover or self-funded arrangement applies.
How to proceed
To see Dr Tsung you'll need a referral from your GP or another specialist. Call reception on (07) 5676 9930 to book your first appointment, or email hello@sgco.au. New patients can pre-register online before the visit; the form prepares your records and does not book an appointment. See contact for location and hours.
You can read more about each procedure on the hip replacement, knee replacement and joint replacement pages.