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Fees for medical services – Dr John Orchard, Sports Physician

FEES

The following fees are for The Stadium Orthopaedic and Sports Medicine practice.  (^) Fees for Level 2, 3 and 4 consultations are slightly cheaper at the Sydney University and Kensington practices, reflecting cheaper practice costs at these clinics.

SERVICE

TIME

FEE

MEDICARE REBATE #

PATIENT GAP

MAJOR SERVICES

Level 4 – Item 447 (Long initial)

40 mins +

$170

$91.40

$78.60

Level 3 – Item 446 (Short initial or long review)

20-40 mins

$135 ^

$62.30

$72.70

Level 2 – Item 445 (Short review)

6-20 mins

$90 ^

$32.85

$57.15

Level 1 – Item 444 (Very brief)

<5 mins

$25 ^

$15.05

$9.95

Cortisone or Aprotinin injection (where practice supplies drug) – Item 50124S

N/A

$35

$22.75*

$12.25

2nd injection in the same consultation – Item ½ of 50124S

N/A

$20

$11.40*

$8.60
OTHER SERVICES

Injection (where patient supplies drug) – 50124P

N/A

$25

$22.75*

$2.25

2nd injection where patient supplies drug – Item ½ of 50124P

 

$12

$11.40*

$0.60

Shock wave therapy (Kensington only) #

N/A

$55

-

$55
Iontophoresis therapy (Sydney Uni only) N/A $25 - $25

Completing paperwork outside of a consultation (e.g. insurance form, referral, prescription writing)

N/A

$20

-

$20

Medicolegal report (up to 800 words)

N/A

$300 + GST

-

$330

* The Medicare system only pays a rebate for injections into a joint or "synovial cavity", an ambiguous statement, as many (but not all) tendons have synovial cavities in their sheaths. This means that injections into some areas are not covered by Medicare.

As you can see, the Medicare system is complicated. You should be prepared to be able to pay up to $200 by cash or credit on the day, although Medicare will rebate significant amounts.

# If sports physicians had equal status with other similar physicians under the Australian medical system (e.g. rheumatologists, rehabilitation physicians etc.) the Medicare rebate for an initial consultation would be $115.90 and for a review consultation it would be $58.00. Shock wave therapy receives a very generous rebate of $547.05 when used to treat kidney stones, but not for treating calcific tendinopathy, despite the evidence that it works for the latter. It is the government that determines that patients of sports physicians receive lower rebates than those of other physicians.

Frequently asked questions about fees:

  1. Are there concession fees?

(^) Health-care card holders, pensioners and full-time tertiary students are given a $20 discount on Level 2-4 consultations.

  1. Why is there no bulk-billing?

The federal government sets the Medicare rebates for different types of doctors. The Medicare rates for Sports Physicians are significantly lower than other similar physicians. Certain patients listed above are given a generous concession on the fee, but this is still higher than the Medicare rebate, so bulk billing cannot be used. See further details below on this topic about who to contact if this issue bothers you. 

  1. What if I want to see a sports physician but cannot afford the fees?

There are other doctors at the clinics (including those with less experience or qualifications) who set fees at a slightly lower level, which may be more affordable for you. 

  1. Does my private health insurance cover any of these fees?

No. Medicare has determined that private health insurance is not allowed to cover doctors’ fees outside of hospitals.

  1. Are the gaps eligible for the Medicare Safety Net?

Yes. If you anticipate that you or your family may have gaps totalling more than several hundred dollars per year, please save the receipts as you may be able to claim some of these under the Safety Net Scheme. For more info, visit: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-medicare-consumers-booklet1.htm

  1. What level of consultation do I need?

Budget that an initial consultation will be a Level 4 and review Level 3. For a single problem affecting the limbs (e.g. Achilles tendinopathy), the initial consultation may be a Level 3 (20-40 mins) and the review consultation will be a Level 2 (6-20mins). If you need some minor paperwork completed (e.g. prescription refill, certificate written) then this will be charged at the rate of $20, which generates a $12 rebate if you attend the clinic for a Level 1 consultation (no appointment necessary). 

  1. Will I need to arrange or pay for any follow-up treatment/paperwork?

Please book a review appointment if you are awaiting the results of tests or scans or you need further treatment. If tests are ordered at a consultation and the results are sent to the practice, the doctor will call if the results are quite abnormal or unexpected. If the results are normal or the outcome of the test does not require urgent follow-up, the doctor will wait until your review appointment before discussing them. Communication of a very straightforward nature (e.g. answering a single question or passing on scan results) can be done over the phone without charge, but please be aware that phone calls may take a while to be returned, as patients at the clinic take precedence. Because of risk of misdiagnosis, I do not engage in lengthy phone calls or reply to emails, so if you have anything other than a simple question you need to organise a face-to-face appointment.

  1. When do I need to pay?

Fees are payable immediately following the consultation. We accept cash, EFTPOS and Visa/Mastercard.

Further note on fees and rebates:

My fees, and those of most sports physicians in Australia, are generally very moderate when compared to:

(1)    Other doctors practising in Australia.

(2)    Other professionals (e.g. lawyers, dentists, vets, accountants, plumbers) practising in Australia.

(3)    Other sports physicians practising in other Western countries (USA, England, European Union, New Zealand)

However, there are still large gaps for patients to pay because the rebates are nowhere near the fees which are charged.

I cannot explain why the Medicare rebates are so low for sports physicians. Someone from the government or Medicare needs to explain this to you. Sports medicine is in the unique position in Australia where it is considered a specialty but those fully qualified in it are not considered specialists. It is a reasonable question to ask, as rebates are lower for sports physicians than for other similar doctors. It does seem inconsistent with claims from our government that physical activity is being promoted when patients of sports physicians are disadvantaged compared to patients of other physicians. You need to take issue with the Health Minister (and perhaps the Sports Minister) if you feel strongly about this and want it changed.