Will you have to pay for anaesthesia?
Most people won't have to pay for anaesthesia. In three quarters of cases, health funds pay for what Medicare doesn't.
For the minority who do
pay a gap fee, the 'gap' being the difference between what a doctor charges and what's covered by health funds and Medicare, the typical out-of-pocket cost is 40% of their entire
anaesthesia fee. Their overall bill tends to be higher too, with average
fees twice that of "no gap" bills. That's because the anaesthetists who
charge a gap are either unwilling or unable to charge the fund-dictated
Anaesthesia is the service most commonly paid for by
private health funds, and it's no mystery why. Anaesthetists are as crucial to operations as
surgeons. "Without anaesthesia, surgeries would involve a heck of a lot of
screaming," jokes president of the Australian Society of Anaesthetists
(ASA), David Scott.
Click here for an accessible version of this infographic.
How anaesthesia billing works
Anaesthetists bill in"units". The number of units they charge for a surgery depends on its complexity, including:
the type of surgery
the duration of the service
whether any monitoring devices are used
the patient's classification on a scale of illness severity
the patient's age if they are less than 12 months or
over 70 years
after hours emergencies, which attract a 50% penalty rate.
A simple procedure usually comes in at around 10 units, and might include
just anaesthesia and the time count. The bill for a more complex operation
could look like this:
Anaesthesia for resection of perforated bowel
Time – 4 hours 40 minutes
Modifier – physical status
Central venous pressure monitoring
Notice that the unit price is the same in each row. The anaesthetist sets
their fees by the unit, not by the whole service. Everything has to be
priced according to its relative unit weight.
Medicare, insurers, and the medical profession all use relative unit
pricing when they talk about anaesthesia billing. And they all have widely
different views on what a fair unit price should be.
Click here for an accessible version of this infographic.
Finding out your anaesthesia costs upfront
It's easy to assume an anaesthetist comes as part of your overall surgeon's
service. In reality, each specialty runs two distinct businesses, and will
bill you separately for their work.
As a private patient, you have your choice of surgeon. But when it comes to other doctors present at your operation, your options are more limited.
A surgeon may work with several anaesthetists – one on this day, another at
this hospital, a third on this type of operation. Likewise, an anaesthetist
will spread their work among different surgeons.
The surgeon usually chooses an anaesthetist based on availability and
expertise. The complicated game of musical operating theatres means that
it's all but impossible for a patient to "shop around" for an anaesthetist.
It may be possible to use a cheaper anaesthetist by delaying or moving your
Informed financial consent (IFC)
This is the principle that a patient is
entitled to be given an estimate of their out-of-pocket costs before going
into surgery. ASA guidelines say the day of an elective surgery is a "less
than ideal" time to be discussing costs, but it does happen.
CHOICE member Helen says she ended up with more than $750 in gap fees for
anaesthesia alone. "I did not meet the anaesthetist until I was in the
operating room with the tranquiliser already having been administered, at
which point it was too late as my mind was fuzzy, and I was past the point
of no return anyway," she says.
"What was I going to do? Climb off the table?"
Some anaesthetists are proactive about providing IFC information. An
anaesthetist CHOICE spoke to has his patients fill out a medical history
questionnaire, if the surgeon's office agrees to pass them on. He might
also have a phone consultation with them, where he talks them through the
details of their anaesthesia and the probable costs. This information is
then confirmed in a follow-up letter.
Scott says best practice is for anaesthetists to speak to their patients
ahead of the surgery, if the timeframe permits. He says surgeons not giving
enough information to patients is "one of our constant problems". As the
doctors with the most prominent, customer-facing roles, he wants surgeons
to inform patients about the big picture.
"Surgeons need to understand that they are the gatekeepers between their
patients and the other practitioners who will be involved in the surgery,"
Scott says. Anaesthetists, as well as pathologists and radiologists, can
also be involved in surgery and attract extra costs.
Ultimately, however, it's up the patient to be aware of the potential costs of
surgery. Doctors sometimes take their patients' capacity to pay into
account when setting prices, so if you'll struggle to pay a fee let them
know – you may be able to negotiate a discount.
What you need to ask
What to ask your surgeon:
- What out-of-pocket costs can I expect for this anaesthetist?
- Did you choose this anaesthetist because of their experience or their
- Do you work with any other anaesthetists who would charge a lower fee?
- Is it possible to use a cheaper anaesthetist by moving the date or location
of the surgery?
What to ask your anaesthetist:
- What is your unit price, and what factors determine it?
- Are you willing to bill using my private health insurance fund's gap
- What out-of-pocket costs can I expect?
- Are you able to charge a lower unit price so I don't pay a gap?
- Are we able to draw up a repayment plan so I can pay in instalments?
- Most doctors have formal agreements with funds around gap fees. If yours
doesn't, that doesn't mean you'll automatically pay a gap. They just need
to charge below your fund's gap threshold.
- Any quote given before surgery is at best an estimate, since complications
during the operation can increase the number of anaesthesia units.
- If you're asked to pay the full fee upfront, get confirmation on whether
this is the final price or if there could be additional charges.
What CHOICE members say
CHOICE asked 697 members about out-of-pocket costs from surgery: how much
they paid, when they found out about them, and how comfortable they were
discussing them with their doctors.
While some were happy with the service and didn't mind having to pay, others felt as though they'd been taken for a ride. Many didn't
speak to their anaesthetist until the day of the surgery – one person said
they didn't speak to them until they were being wheeled into the theatre.
Jenni says she "did not realise that they [anaesthetist's costs] were not
part of the general hospital costs. It did not occur to us – foolish as it
sounds – that there was an additional medical specialist involved, given
you do not ever meet with them."
Mark had more pressing concerns than discussing fees. "As getting rid of
the cancer was the focus, I didn't think to," he says.
Some were reluctant to even raise the issue of the bill. "It felt very
uncomfortable, as I was in a powerless position and was embarrassed to
express financial concerns," says another member.
The out-of-pocket costs caught many members by surprise, as they hadn't
been informed before the operation about what would be involved and how
much each item would cost.