Understanding Your Private Health Cover
At our practice, fees are based on the rates recommended by the Australian Medical Association (AMA). Regardless of which health fund you are with, there will be some out-of-pocket expenses. We will provide a detailed estimate of these costs and encourage you to contact your health fund directly to confirm your level of cover for the proposed procedure.
We understand that private health insurance can be complex and, at times, confusing. Our team aims to be as transparent and supportive as possible when discussing your cover and associated fees.
Waiting Periods and Pre-existing Conditions
Please ensure that you have completed the standard 12-month waiting period with your health fund before proceeding with surgery.
It’s important to note that most ENT conditions are considered pre-existing by health funds. If you consulted a GP, received a referral, or sought treatment for the condition prior to joining your health fund, the insurer is likely to classify it as pre-existing—meaning you must serve the full waiting period before benefits are available.
Some health funds may waive or reduce waiting periods for conditions they do not consider pre-existing, but this is rare for ENT-related issues.
If you choose to proceed with surgery during your waiting period, you may still do so, but you will be considered an uninsured patient for that procedure and will be responsible for the full cost of treatment.
Concerned About Your Rebate?
We understand that some patients are surprised or disappointed by the rebates provided by their health fund. While we do not promote or endorse any specific insurer, we acknowledge that there are significant differences between funds in terms of the value they provide.
If you’re dissatisfied with your current level of cover, we encourage you to review and compare other options. You can explore alternative policies and compare health funds via the official government website: www.privatehealth.gov.au
Thinking of Switching Funds? Here’s What You Should Know
Portability & Protections Under the Law
The Private Health Insurance Act 2007 includes “portability” rules. Portability means that when switching funds that there are no penalties or exit fees.
Waiting periods are Waived for Comparable Policies
If you move to a similar level of cover, any waiting periods you’ve already served will be recognised by your new fund—meaning you won’t have to start over.
The Process is Simple
Once you’ve chosen a new policy, your new health fund will manage the transfer on your behalf. After you give them authorisation, they will cancel your existing policy, collect your membership details, and ensure any unused premiums are refunded to you.
Ears Nose Throat Newcastle
218 Pacific Hwy
CHARLESTOWN NSW 2290
Entrance via Pearson St Mall