Depending on your company and level of cover with your health fund, an out-of-pocket balance may occur for your planned procedure.

Private health insurance policies have 4 tiers: Bronze, Silver, Gold and Basic. With regards to pain management procedures, it is important to note the 2 key categories and where your procedure fits.

1. Pain management procedures WITHOUT A DEVICE (neurostimulator) will be covered by all 3 tiers EXCEPT Basic or Extras.
   • There could be more out-of-pocket expenses for bronze/silver.
2. Pain management procedures WITH A DEVICE (neurostimulator) are available to Gold ONLY.
   • Optional to all other tiers
   • CHECK with your insurance company if Neuromodulation devices (stimulator trial or implant) are covered.

Click here to learn more about tiers.
Click here to refer to the government website on private health insurance.

Questions to Ask Your Health Insurance

• Does my policy cover me for this procedure? – Metro Pain Group will provide you with the appropriate item numbers.
• Do I have an “excess” payment on my insurance policy?
• Are there any co-payments required for each night I will be in hospital?
• Does my policy exclude some treatments – for example cardiac, orthopaedic or rehabilitation?
• Are any prosthetic or disposable items used in the surgery not covered by my insurance?

What May Not Be Covered by My Health Fund?

• Pharmacy (medicines required during your admission and discharge medications)
• Pathology (e.g. blood tests)
• Assisting surgeon
• Other consultants
• Ambulance transfers

All estimated out-of-pocket expenses are payable before or upon admission.

Going Ahead with Your Procedure

You will be contacted by the various providers confirming rebates or out-of-pocket expenses: Talk to our Doctor support team (Medical Assistants)

Un-insured or self-funded patients are required to cover the following fees associated with the procedure at Monash House Private Hospital (MHPH) which includes the proceduralist, anaesthetist and imaging involved. Payment MUST be received prior to or on the day of Admission.

1. Proceduralist fees – these fees are eligible for a rebate from Medicare.
2. Anaesthetist fees (for sedated procedures) – these fees are eligible for a rebate from Medicare which will be provided by another company.
3. Monash House Private Hospital fees or a different hospital fees – theatre/bed fees and consumables. These costs are determined by the type of procedure. There is no rebate on these fees.
4. Radiology fees – these fees are eligible for a rebate from Medicare.

Total Estimates for Your Procedure at Monash House Private Hospital (MHPH)

You will be emailed ESTIMATES by MHPH for the above providers. Please confirm via email or call your doctors’ rooms as soon as possible.

• You have 2 business days to respond if your procedure is booked within 1 month.
• You have 5 business days to respond if you are booked more than 1 month away.

Total payment (aside from any ancillary charges) must be made on admission unless approval for admission has been confirmed by your insurance company.

Department of Veterans’ Affairs

Department of Veterans’ Affairs (DVA) patients will have their account directly sent to the DVA for payment.

Gold card holders are covered for all care. White card holders are covered subject to approval by DVA.

Workers’ Compensation or TAC

Workers’ Compensation and TAC patients need to ensure their admission has been approved by the appropriate insurance company prior to admission, and a copy of the approval has been provided to Metro Pain Group and Monash House Private Hospital.