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Fees and Billing

Consultation Fees

At the time of making your appointment you will be advised of the cost of the consultation and the amount that you will receive back from Medicare. We are able to make a patient claim through Medicare at the time of your consultation so that the amount claimed is deposited back into the bank account you nominated with Medicare overnight. 

We have a discounted fee for those patients holding a blue pension card.

Northern Rivers Orthopaedics respectfully requests payment at the time of the consultation.  We accept cash, cheque, MasterCard or Visa and have eftpos facilities.  We are not a bulk billing practice.

WorkCover and CTP claimants are requested to arrange for their insurer to fax through an approval for the consultation with their claim number on the approval PRIOR to the consultation.  All fees will then be billed to the insurer.

DVA patients are requested to bring their DVA card with them to the consultation.

Surgical Fees

Dr Prodger operates publicly at the Lismore Base Hospital and the Casino Memorial and District Hospital.  The fee for the surgery will be billed to the NSW Local Health District.  Post surgical reviews after surgery in Dr Prodger’s rooms will be charged to the patient at the usual follow up consultation fee rate.

Dr Prodger operates privately at St Vincents Private Hospital, Lismore. 

After your consultation, if you require an operation our staff will provide you with an itemised quote which details an estimate of fees.  This is your informed financial consent.

Your out-of-pocket expenses depend on: What type of surgery you have, what items number/s are used and what health fund you are with.

Every operation has a different item number/s and every health fund has a different schedule of fees for each item number and policy for payment.  This can be difficult to understand so we encourage you to speak to our friendly staff about any queries you have with your estimate of fees.  It is recommended that you speak to your health fund directly regarding the estimate of fees and any out-of-pocket expenses you may be responsible for such as a hospital excess.

Fees for operations performed in a Private Hospital may be billed in a number of ways, depending on what type of operation you are having and what private health insurance fund you are with:

  • Your fees may be 'No Gap' fees, where there is no out-of-pocket expense to the patient.  In this case the surgery fee is billed directly to the private health insurance fund.  In most cases joint replacement surgery will be billed in this manner.
  • Your fees may be "Known Gap' fees, where there is a maximum known gap billed to the patient.  Most of the larger private health funds offer this scheme, such as BUPA, Medibank Private and HCF.  In this case the patient is required to pay a gap which is capped at a maximum of $500.00 but may be less.  The remainder of the surgical fees is billed directly to your private health insurance fund.
  • If your private health insurance fund does not offer a 'No Gap' or 'Known Gap' scheme (usually these are the smaller funds), then there may be higher out-of-pocket expenses.  As stated you will be provided with the estimate of fees after your consultation so that you are aware of the 'gap'.

Dr Prodger has a number of aims with his practice.  The first is to provide the highest possible orthopaedic opinion and surgical care. The second is to offer affordable health care to his patients by participating in the 'No Gap' and 'Known Gap' schemes where possible.

It is worth considering that your private health insurance offers you choice of surgeon and choice of date for your surgery. Your private health insurance assists greatly with the hospital fees, however there is varying support for the surgical fees between funds.

If you do not have private health insurance you can still have your surgery performed privately at St Vincents Private Hospital.  Dr Prodger’s rooms are able to provide you with an estimate of fees for your surgery that will outline the fee for Dr Prodger, the hospital/theatre fee, prosthesis fee if applicable and the rebate that you receive back from Medicare.  You will be able to contact your anaesthetist directly for an estimate of their fee.  

Dr Prodger requests that any out-of-pocket expenses are paid seven (7) days prior to the scheduled date of surgery.