Finances
Understanding Fees and Insurances for Oral and Jaw Surgery
Fees and Private Health Insurance
Understanding surgical fees in the private sector can feel complex. This page explains how fees are structured at Elevate Oral & Jaw Surgery, what may be covered by Medicare and private health insurance, and what you should expect before your procedure is confirmed.
We recommend reviewing this information carefully and contacting your health fund early to confirm your level of cover, waiting periods (often up to 12 months for major surgery), and whether your policy includes the relevant item numbers.
How Procedures Are Categorised
Dental Procedures
These include most tooth extractions, minor oral surgery, and dental implant placement. These are billed using three-digit dental item codes and are not claimable through Medicare.
If you hold dental extras cover, you may receive a rebate from your private health insurer; however, rebates vary significantly depending on your policy. These procedures do not involve a hospital insurance component.
Medical Procedures
These include jaw surgery, TMJ surgery, and other complex oral and maxillofacial procedures. These are billed using five-digit Medicare Benefits Schedule (MBS) item numbers.
Medical procedures may attract:
- A Medicare rebate
- A contribution from your private hospital insurance
Importantly, classification depends on the nature of the procedure, not the location in which it is performed. Having surgery in a hospital does not automatically make it a Medicare-claimable procedure.
Specialist Registration & Billing Pathway
Dr Krishnan Parthasarathi holds both dental specialist registration and medical specialist registration in Oral and Maxillofacial Surgery.
Where a procedure qualifies under the medical system, it is billed through the MBS rather than dental item codes. In practical terms, this may allow patients to access Medicare rebates that would not otherwise apply in a purely dental billing framework.
The Three-Part Fee Structure
For procedures performed in a private hospital, there are typically three separate fees. These are billed independently by different providers:
- Surgical fee — billed by your surgeon
- Anaesthetic fee — billed directly by the anaesthetist
- Hospital fees — billed by the hospital for admission, theatre, and accommodation
Each provider will contact you directly regarding their portion of the billing.
Gap Fees
Elevate Oral & Jaw Surgery does not participate in No-Gap or Known-Gap arrangements with private health funds.
This means that for certain procedures, there may be a gap fee between the surgeon’s fee and the combined rebates from Medicare and your health fund.
A detailed written quote will always be provided prior to your procedure. This will outline:
- The surgical fee
- Applicable MBS item numbers
- Expected Medicare rebates
- Estimated private health fund contributions
This ensures your estimated out-of-pocket cost is clearly understood in advance.
We Welcome All Health Funds
Our Preferred Providers Are
Payment Options
We offer multiple convenient payment methods to suit your preferences:
- Credit/Debit Card (Visa, Mastercard, American Express)
- EFTPOS
- Cash
- Direct Bank Transfer
Understanding Jaw Surgery Billing
What to Expect — Out-of-Pocket Costs
Anaesthetic fee
Surgical gap fee
Hospital excess
Patients Without Private Health Insurance
If you do not hold private hospital cover, you will be responsible for hospital and anaesthetic costs in addition to the surgical fee.
For elective procedures, we recommend obtaining a cost estimate directly from the hospital before confirming your booking.
Medicare rebates may still apply to eligible MBS items, regardless of private health insurance status.
Questions About Your Fees
If you have any questions about your quote, item numbers, or expected health fund coverage, please contact us.
Note: All fees and payment information will be clearly explained before any treatment is undertaken.
