For patients

Your condition will be assessed and treated based on all available information. Many conditions do not require surgery and can be managed with a combination of physiotherapy, injections, orthotics, braces or modification of footwear. For some conditions a trial of non-surgical management is recommended first, depending on the success surgical treatment may subsequently be advised.

If surgery is required, then the proposed operation will be explained, as well as any risks and the proposed benefits.

A second consultation is sometimes useful to further discuss surgery and the likely outcomes. It can also allow time to discuss with family and friends.

Mr Talia is happy to provide a second opinion about your condition if you are seeking one, please make us aware this is the purpose of your visit when you are booking. It is not mandatory, but it does help a great deal if you are able to bring along any previous notes, letters or imaging to your appointment so we can provide an opinion with the most information possible.

If you would like a second opinion after consultation with Mr. Talia then we can of course recommend another specialist to review you and provide their opinion on your condition. It is part of medical practice and very common to seek and to provide these second opinions prior to any surgery, especially in complex cases.

Surgery can be an anxiety-provoking. Our team will try and make it as smooth as possible and allay any concerns you may have. The staff both in the rooms and at the hospital will do our best to assist you from admission through to discharge and post-operative care.

Please see the following video which provides an idea of what to expect for your surgery at our hospitals.

https://www.youtube.com/watch?v=ZSxDJ15V930&t=11s

We are happy to see patients who have injuries as a result of work accidents or road accidents. Please make our staff aware that this is an appointment relating to a WorkCover or TAC claim when booking the appointment. Please bring your claim number and any consultation approvals along with you to your appointment. If you do not yet have a claim number, we are still happy to see you of course, but you will need to pay the full account on the day of consultation and it will be your responsibility to claim back the amount back from WorkCover or TAC afterwards.

 Please note that if you require surgery for a work or TAC related condition, it can only be scheduled with Mr Talia after approval from the relevant insuring body. The process of obtaining approval for surgery can often take several weeks.

We are happy to see patients who are covered with DVA. Please bring along your DVA card and any consultation approvals. If surgery is required then depending on your level of cover (white/gold) it may take some time to obtain surgery approval before we can schedule a date for the procedure. This can take several weeks in some circumstances.

If you are booking surgery - After your consultation, you will be provided with financial information from Mr Talia’s assistant Julia or Stephanie.

This quote will outline the estimated surgical fees and rebates prior to booking surgery.

This will clearly outline the fees and the out-of-pocket costs.

There may be a change to the surgical fee after the procedure if there are unforeseen circumstances or findings that Mr. Talia must address during the procedure, note this is very rare.

Do I need to have private health insurance?

Private Health insurance allows you and your family to access the right health services at the right time. You have control of your health care and can choose the provider, facility and timing of your treatment. You have access to both The Avenue Hospital and Epworth Hospital Richmond and can rest assured that your health is in good hands. Both hospitals offer modern facilities and excellent staff that provide outstanding patient care.

Factors contributing to out of pocket costs

Several factors contribute to your out of pocket cost when undergoing surgery in a private hospital.

The total cost for surgery is comprised of:

• Surgeon’s fee

• Anaesthetist fee

• Assistant surgeon fee

• Private hospital excess – this may be applicable depending on the policy you have taken out with your health fund. We are not responsible for these costs.

• Private hospital fees – this is typically covered by your health fund as long as they cover the procedure, we will provide you with the procedure item numbers so you can check, ahead of time, what your health fund will and will not cover. 

Orthopaedic implants are typically covered by health insurance companies.

Surgical fees

The out of pocket cost (or “gap”) is determined by the total surgical fee, minus the rebate that is set by your health fund and medicare (they each contribute a portion). Rebates provided by medicare and health funds will usually be lower than the surgical and anaesthetic fee due to inadequate indexation over many years. This means that in most instances there will be a part of your consultation and surgical fee that will not be covered by Medicare and your health fund (the ‘gap’). If there is any problem with this, it is important that you ask about this. Our staff are fully informed with changes and rebates.

• The surgical fee includes initial follow up appointments in the rooms to 6 weeks post op.

• Your health fund and the policy you have taken out with them will determine the rebate you receive.

The out of pocket can vary significantly depending on your health fund’s rules and the policy you have taken out with them.

Private health insurers offer "gap schemes," where they set capped fees that specialists must accept. These rates are usually well below the recommended fee schedule and allow insurers to control the value of specialist care. Dr Talia does not typically participate in these schemes to ensure the surgical fees reflect the time, expertise, and complexity of each procedure. A full written quote is always provided before surgery.

If your fund offers “known gap” or “no gap” schemes then ironically your out of pocket may be significantly higher, due to their rebate rules. Mr. Talia typically does not participate in the health fund’s gap-cover schemes.

You should be aware that different insurance companies vary greatly in the types of coverage available. (e.g. Latrobe, Mildura and NIB typically rebate at lower rates than most other health providers). Also, some companies take care of claims promptly while others delay payment for several months.

Self-funded (uninsured) patients

If you do not have private health insurance, we are still of course happy to see you. If surgery is required then a quote for surgery will be organised. The quote for surgery is an estimate of the total surgical cost, including what the health funds would normally cover.

For Self-funding patients - The total fee will consist of:

• Hospital fees – a quote for this will be organised by The Avenue or Epworth

• The difference between Mr Talia’s surgical fee and the medicare rebate

• The gap for radiology, pathology services

• Physiotherapy services

• Orthopaedic implant fees

• Anaesthetic fees

• Assistant surgeon fees

Please see the following links which go some way to explain some of the reasons behind this variation in fees.

• “Doctors call for private health insurance watchdog amid gaps in coverage”
  The Age, Dec 2021

• “Mind the gap: how do medical specialist fees work?”
  Sydney Morning Herald, June 2019

• Australian Government: What private health insurance covers / Out of pocket costs

• Better Health Channel Victoria: Hospital Costs and Payments

Pensioners / Healthcare card holders

Please make our staff aware if you have a pension or healthcare card and bring this along to your consultation if applicable. This will influence the fees for surgery.

Tax rebates

A rebate may be claimed through your end of year tax return if you incur medical expenses.

As always, check with a licensed tax accountant or financial advisor.

Further details can be found by clicking here.