Fees & Gap Payments
Understanding your out-of-pocket costs
We understand that healthcare costs can be confusing. This page explains why gap payments may occur and what you can expect when receiving care at our clinic.
Our goal is transparency, so you can make informed decisions about your care with confidence.
What is a gap payment?
A gap payment (also called an out-of-pocket cost) is the difference between:
- the fee for your medical care, and
- the amount covered by Medicare and/or your private health insurer.
In most cases, Medicare and private health insurance contribute toward your care, but do not cover the full cost of providing specialist breast services.
Why do gap payments exist?
Gap payments are not unique to this clinic — they reflect how Australia’s healthcare funding system is structured.
Healthcare costs are shared between three components:
- Medicare (government rebate)
- Private health insurance (where applicable)
- Specialist medical fees
Over time, Medicare rebates have not kept pace with the rising costs of delivering modern medical care, including staffing, facilities, equipment, insurance, and compliance requirements.
As a result, the rebate contributes only part of the total cost, and the difference becomes the gap.
This is a structural issue across the healthcare system, not specific to any individual doctor or clinic.
Why Medicare does not cover the full fee
Medicare provides a scheduled rebate for eligible services. However:
- rebates are set nationally
- they do not reflect the full cost of delivering specialist care today
- they are updated at a rate that has not matched real-world healthcare costs over time
Medicare is designed as a contribution to care, not a full payment system.
What role does private health insurance play?
Private health insurance may help cover some hospital and procedural costs, depending on your policy.
However:
- insurance cover varies widely between funds and policies
- not all specialist fees are fully covered
- patients may still have an out-of-pocket cost
We recommend confirming your level of cover directly with your insurer before treatment.
Why costs can vary between patients
Gap fees are not the same for every patient. They may vary depending on:
- the type of consultation or procedure required
- the complexity of your care
- hospital and theatre requirements (if surgery is needed)
- your level of private health insurance cover
Any expected costs will always be explained to you before proceeding with treatment.
Will I know the cost before treatment?
Yes.
We believe in informed financial consent. This means you will be clearly informed of:
- Medicare rebates applicable to your care
- any private health insurance contributions
- any out-of-pocket gap fees
This discussion happens before any treatment proceeds, so you can make fully informed decisions.
Can I get an estimate of my gap?
Yes. In most cases, we can provide an estimate after your initial consultation or once a treatment plan has been discussed.
Because every patient’s clinical needs are different, fees are tailored to the care required.
Where can I learn more about gap payments?
For patients who wish to better understand how gap payments arise within the broader Australian healthcare system, independent medical organisations provide further context on funding structures and rebate settings.
Australian Medical Association – The Gaps That Create Gaps
A final note
We understand that cost is an important consideration when accessing healthcare.
If you have any concerns about fees or insurance coverage, please let us know. We are here to help you understand your options clearly and ensure cost is not a barrier to receiving appropriate medical care.