Financial Consent

This document is designed to provide you with information regarding the financial aspects of your proposed surgical procedure. It is important that you fully understand your financial obligations before proceeding with the surgery. If you have any questions regarding this consent, please do not hesitate to ask your surgeon or their office staff for clarification.

When you receive medical treatment as a private patient, the total cost of your treatment is typically shared between Medicare, your private health insurer, and yourself. However, there may be a gap fee, which is the portion of the cost not covered by Medicare or your health insurance. This fee becomes an out-of-pocket expense for you.

Cost Breakdown

  1. Medicare Coverage:
    Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee for in-hospital services.

  2. Private Health Insurance:
    Your health insurer covers the remaining 25% of the MBS fee.

  3. Dr Cole’s Fees:
    Dr Cole’s fees are based on the fees Australian Medical Association (AMA) Fees List. This amount is not covered by Medicare or your health insurance, it is a gap fee payable by you. The fee estimate may include fees for the Surgical Assistant.

How Fees are Calculated: Australian Medical Association (AMA)

Dr Cole’s fees are calculated based on the Australian Medical Association (AMA) Fees List, which provides a comprehensive guide to the fees for medical services in Australia. The AMA Fees List is updated regularly to reflect changes in the Medicare Benefits Schedule (MBS), ensuring they are in line with current medical practices and costs.

Following your Initial Consultation with Dr Cole an indicative estimate is provided based on the procedure as discussed with Dr Cole.  The estimate is for Dr Cole’s surgical and in-hospital consultation fees, and may include the Surgical Assistant Doctor’s services. It does not include any out-patient consultations.

The fee estimate breaks down the cost so that you can see how much you will receive from Medicare and your private insurer, as well as the estimated out-of-pocket amount owed by you. Full payment of the total estimated amount is due prior to your hospital admission. After your procedure we will provide an itemised invoice for you to take and submit to Medicare and your private insurer to claim the rebate amounts. The figures provided regarding your Medicare and health fund rebates are an estimate only. For a more accurate figure, please contact your health fund directly to discuss your rebate eligibility and amount.

It should be noted that the fee estimate provided is for the specified services and procedures only. Intraoperative findings may result in variations to the actual procedure performed. The final fees will be based on the actual procedure performed. Additional services or treatments may incur additional fees. If applicable a final invoice for any outstanding fees will be sent to you following your discharge from hospital, with payment required within 7 days. Payment details and instructions will be on the invoice. 

In-Patient Care

The fee estimate provided includes a pre-operative review with Dr Cole upon admission to hospital, and postoperative care and management in hospital for the first 7 days following surgery. If your stay in hospital extends beyond 7 days a fee of $160 per postoperative consultation by the surgeon will be applied. 

Payment Responsibility

You understand that you are responsible for the payment of the fees outlined above, regardless of whether your health insurance covers these costs. The financial obligations may include:

  • Gap Fees: If your private health fund does not cover the full cost of the surgery, you will be responsible for any out-of-pocket expenses (ie.Gap fees). 

  • Health Insurance: If you are insured, you agree to provide your health insurance details, and understand that you are responsible for ensuring that you are up to date and have served the required waiting periods, and for verifying with your insurer the level of coverage you are entitled to, and for settling any gap fees not covered by the insurance. The figures provided in the quote regarding your health fund rebate are an estimate only, and apply to patients who are eligible to claim through Medicare and their private health fund for the listed item numbers. For a more accurate  figure, you should contact your health fund directly to discuss your rebate eligibility and amount.

  • Payment Schedule: 

    • Fee Estimate - This will be provided to you in advance, with payment of the total estimate fees due prior to your hospital admission. Payment details and instructions will be on your fee estimate.

    • Medicare and Health Insurance Rebates - We will provide you with an itemised invoice after you have been discharged from the hospital, so that you can take it with you to submit to Medicare and your health insurer to claim the rebates following your procedure.

    • Final Invoice - This will be sent to you after you have been discharged from hospital for any outstanding fees that apply. Payment is required within 7 days. Payment details and instructions will be on the invoice.


Team-Based Care and Separate Invoices:

Cardiac thoracic surgery involves a multidisciplinary team of healthcare professionals, each contributing their expertise to ensure the best possible outcome for the patient. 

To do your operation Dr Cole will organise a team of three or four people:

  1. Himself

  2. An Assistant Surgeon or Nurse Practitioner Assistant

  3. A Specialist Cardiac or Thoracic Anaesthetist

  4. A Perfusionist (if required): This is a specialist doctor who runs the heart lung machine

Dr Cole’s team of doctors have fees which are separate to Dr Cole’s fees. They will contact you directly regarding their fees. You will have separate financial arrangements and Informed Financial Consent with each provider.

Specialist Nurse Practitioner Assistant:

Currently health funds do not compensate Specialist Nurse Practitioner Assistants.  If there is no doctor available to assist Dr Cole, then he may arrange for a Specialist Nurse Practitioner Assistant.  These are nurses who have undertaken specialty training and further degrees to train in order to assist surgeons in theatre.  Some have specific skills for assisting in cardiac surgery in particular.  If they are arranged for your operation, then they will invoice you directly for their assistance.  Fees are generally between $300 and $500.

Other Costs

Hospital or Facility Fees: This includes the cost of using the operating theatre, ICU, recovery room accommodation, nursing and other hospital services. These fees are usually billed separately by the hospital, directly to your private health fund. These are usually fully covered by Medicare and Private Health Funds, depending on your coverage. 

Specialists: Other medical specialists (eg. Cardiologists, Respiratory Physicians, Endocrinologists) may be asked to consult during your care if considered necessary. They will individually have separate financial arrangements with you.

Additional Costs: There may be additional costs related to Pathology, Radiology, medical supplies, medications, and other services required for your care. These are usually partially covered by your health fund, depending on your coverage. You may get bills from these services, but in general, these are small amounts.  We note however, that if a large number of tests are required, the costs can add up to large amounts.

We recommend that you contact your private insurance company directly to discuss your insurance cover, as well as your rebate eligibility and amounts for these additional services.

Insurance and Medicare

  • Medicare: If you are eligible for Medicare, your surgical procedure may be partially covered by Medicare. The Medicare Benefits Schedule (MBS) lists suggested total fees to be charged for medical services, and the amount that the Federal Government will contribute for specific services. Ie. The Medicare Rebate. To find out the rebate amount you would be eligible to receive for your procedure, go to the MBS website and enter your procedure item number. It is available online and searchable here.  A list of common item numbers can be found here.

  • Private Health Insurance: If you have private health insurance, please ensure that the surgeon’s office has a copy of your health insurance details. You should check with your private health fund regarding coverage for the procedure and any gap payment that may apply.

  • No Insurance: If you do not have health insurance, you will be required to pay the full cost of the surgery and related expenses.

Consent to Fees and Financial Arrangements

I confirm that I have been given the opportunity to ask questions about the costs associated with my surgery. I acknowledge that I am financially responsible for any medical services and procedures not covered by my insurance or other third-party payers. I agree to make payment arrangements in a timely manner in accordance with the surgeon’s office policies.

I confirm that I have been provided with an estimate of the surgical costs by my surgeon, including estimated rebates and the gap amount payable by me. I understand that the fees may change depending on the specifics of the surgery, and I agree to be notified of any changes as soon as possible.

Acknowledgment and Signature

By submitting this form, I acknowledge that I have read and understood the information provided, and I consent to the financial arrangements related to my surgical procedure. I am satisfied with this information and understand my financial responsibilities and agree to the terms outlined above.


Version Date 5/12/2024