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February 2020

The importance of financial consent in healthcare — a lesson I learnt the hard way!

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Financial consent in healthcare is a subject seldom spoken about. One of the issues is because takes a rocket scientist to understand the financial aspects of our health care system. Health fund rebates, Medicare rebates, schedule fees, no gaps, bulk bill, assistant fees, implant costs, incidental costs — what do all these words mean? And why are they important?

My not-so-great experience with unexpected medical bills

I was having a particularly busy day last May. So busy that I didn’t have time for lunch and was happy to find a hard piece of licorice “chew chew” in my work bag. So busy that I didn’t have time to suck my “chew chew” and ended up grinding down hard on a sharp wedge of licorice that split one of my canine teeth. I was devastated. I spent the rest of the day chatting to my patients while in significant pain and then cried after the dentist told me I would need to have the tooth pulled. Being a pirate is NOT a good look for a plastic surgeon.

But once the hurt of my ageing tooth passed, the agony of the cost of a dental implant started to take effect. The news of my dental extraction, dummy tooth insertion and three stage dental implant was drip fed to me. The financial hit came in increments that were almost as sharp as the initial piece of licorice that delivered me to the dentist’s chair.

I was truly financially cranky because financial consent was not a part of my dental implant process. Noone sat me down in a quiet room and gently talked me through the costs. I am now very grateful to have had an uncomplicated dental implant but I had taken my own thorough practices for financial consent In healthcare for granted.

Plastic surgeons are well and truly the most upfront, efficient and experienced doctors in delivering financial consent when it comes to their patient’s surgeries and care. Ironically, this is because our surgery is elective. Patients have a choice to go ahead with their procedure and significant choice in picking the surgeon, hospital and devices they would like to use. If the price is not right, they can elect to get a second opinion or not go ahead with the procedure.

What is financial consent in healthcare?

Financial consent in healthcare is a meticulous estimate of your fees which you agree upon prior to surgery. I say estimate because unfortunately, no surgeon has control of Medicare, hospital costs or mother nature.

In my practice atSouthern Aesthetic Plastic Surgery, a patient will receive the following information that will allow them to financially consent to any services we provide:

  1. On the day of consultation: Clients will receive a Surgeon and Surgical Assistant’s fee estimate and expected rebate. A rebate can only be expected if the procedure has a Medicare item number. For example, a breast lift only attracts a rebate from Medicare if two thirds of the patient’s breast gland sits below the inframammary fold and their nipples point downwards.In addition, patients are given a “Booking process” information sheet to explain the NSW Medical Board rules about cooling off periods, as well as expectations regarding surgical deposits, refunds, cancellation fees and the costs of revisional surgery.
  1. Within 7 days of consultation: Clients will receive the hospital estimate, anaesthetist’s estimate and cost of medical devices, eg. breast implants.
  2. Day 1 post operation: The client will receive a surgical receipt, which is issued to the patientand can then be taken to Medicare and the patient’s health fund to collect their rebates.

The role of Medicare

Traditionally, medical and surgical professionals have not felt the need to provide a detailed financial consent in healthcare practices as they deem their services essential.

It is important to realize that Australians are remarkably fortunate to always have the ability tochoose their doctor. You should always ask what the costs of surgery are before agreeing to a procedure. If it seems too much, then call other doctor’s rooms for an estimate or speak to your GP about an alternative person to see.

The final important point is that all essential surgery is covered by Medicare. Any Australian requiring surgery to treat cancer or a trauma (eg. hand fracture) can have this surgery performed, for free, in the public health care system.

Dr Amira Sanki is a highly-accredited plastic surgeon practicing in Sydney, Australia. She is an owner of Southern Aesthetic Plastic Surgery, which is based in Kogarah, Miranda and Newtown.