Health Insurance
Initial Consultation
The initial consultation will incur a fee.
A quotation of this fee will be given at the time of your booking. This fee is payable at the time of your appointment and a Medicare claim can be lodged on your behalf
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 healthcare and can choose the provider, facility and timing of your treatment. With the security and protection of private health insurance, you have access to a range of private hospitals that Dr Pourgiezis operates.
All private health funds are accepted within our practice.
The standard fees charged by our rooms are in line with the Australian Medical Association recommended fee schedule. This means that in most instances there will be a ‘gap’ between our surgical fee and what is covered by Medicare and your health insurance fund. Patients are fully informed of any out of pocket expenses at the time of booking surgery.
If you require more information regarding ‘gap’ payments please do not hesitate to call and speak to Dr Pourgiezis’ friendly staff.
Workcover
Dr Pourgiezis consults Workcover patients guided by the state government insurance regulators. This ensures that workers have priority access to Dr Pourgiezis’ professional expertise and treatment is received in a timely manner.
Self Insured
Dr Nick Pourgiezis is pleased to see uninsured patients in his private practice following referral from the patients General Practitioner. He is pleased to assess and offer advice on management options for Orthopaedic problems which may include proceeding with care in the private setting, referral to a public waiting list or if indicated referral to another Specialist.
To avoid being on a long waiting list at a Public Hospital, you may choose to have your treatment as a self-funded private patient, even if you have no private hospital cover. Private admission with Dr Pourgiezis to Western, Ashford or Memorial Hospitals for surgical treatment will incur a number of costs including:
- Hospital fees including accommodation (bed charge) and theatre fees. These costs must be paid at the time of admitting to hospital.
- All surgical equipment required to perform your operation such as implants and single-use disposable theatre equipment.
- Fees associated with Physiotherapy care.
- Costs associated with diagnostic services (medical imaging and laboratory tests), however, some of these services may be bulk billed to Medicare, that is no ‘gap’.
- Fee charged by Dr Nick Pourgiezis which will be partly claimable from Medicare following surgery.
- Fee charged by the Anaesthetist which will be partly claimable from Medicare following surgery.
- Surgical Assistant fee which will be invoiced to you following surgery.
Essentially this means you must meet all costs of the admission yourself. Proceeding as a private patient without private health insurance can be very expensive and will also mean you are liable for any costs that occur if there are complications following your procedure.
Approximate cost of surgery for a self-funded patient: $ 6,200
Knee Arthroscopy $25,000
Total Knee Replacement $24,000
Anterior Cruciate Ligament Reconstruction $11,000
Shoulder Arthroscopy + Subacromial Decompression + Rotator Cuff Repair $13,000
For further information about proceeding as a self-funded private patient, and an itemised quote including all the above fees please discuss this with Dr Nick Pourgiezis’ staff at the time of your consultation.
Regarding referral to the public system it is important to note that The Royal Adelaide Hospital no longer allows Specialists to refer to that service as they have done in the past. General Practitioners will now need to organise uninsured patients to be referred directly to the Royal Adelaide Orthopaedic Out-Patient Clinics.
What actions can I take to avoid long waiting periods at a public hospital and receive my surgical treatment with the Surgeon of my choice?
Most private health insurance companies have a 12-month waiting period for a pre-existing problem / injury. This is significantly less than the waiting period at a public hospital (2 year minimum). Discuss your options with the health insurance company of your choice.
Having private health insurance is an important and cost-effective method of protecting you against unexpected health issues and providing you with more control over your health care, choice of services and choice of doctor.
What if I choose to be referred to a Public Hospital?
Dr Nick Pourgiezis is happy to provide a referral to the Orthopaedic Outpatients Clinic at the Queen Elizabeth Hospital at which time you will be discharged from his private care and await correspondence directly from the public hospital. All referrals are sent within 1 week of your consultation with Dr Nick Pourgiezis. Your referral to the public system is triaged by the public hospital and Dr Nick Pourgiezis staff cannot assist further with your appointments or waiting time in the public system.
Please let us know how we can best assist you with your care.
Click here for more information