Podiatric surgery is a specialist field in the podiatry profession. Podiatric surgery is the surgical treatment of conditions affecting the foot, ankle and related lower extremity structures by accredited and qualified specialist podiatrists.
On 16 March 2005, the Minister for Health and Ageing approved a number of podiatrists to become accredited podiatrists (podiatric surgeons) for the purpose of paying private health insurance benefits.
Will Medicare pay benefits for Podiatric Surgery?
As there is no Medicare item number for a podiatric surgeon’s services or the associated anaesthetist’s service, it is not mandatory for a health fund to pay benefits from their hospital tables for these medical costs. Medicare will not provide a benefit toward the surgeon and anaesthetist’s fees.
What podiatric service costs will CBHS cover?
If podiatric surgery is included on your hospital policy, and if your foot and ankle surgery is performed by an accredited podiatrist, CBHS will pay the minimum default benefit toward hospital costs. Please note that Podiatric Surgery is excluded from FlexiSaver Hospital and Active Hospital covers and no benefits at all will be paid.
What are default benefits?
The default benefit covers the accommodation cost of being treated as a private patient in a public hospital in a shared room (a private room may attract an out-of-pocket expense). Default benefits will only cover a portion of the accommodation cost and will not cover any of the theatre fees in a private hospital. This means if you have podiatric surgery in a private hospital you may be significantly out-of-pocket.
Will CBHS pay for theatre fees for podiatric surgery?
No, CBHS will not pay for theatre fees for podiatric surgery.
Will CBHS pay for the prostheses cost?
Yes, CBHS will cover the cost of a prosthesis that is associated with the surgery and as per the Government approved Prostheses List.
Will CBHS pay the cost of the Accredited Podiatrist?
Yes, CBHS will pay for services performed by an accredited podiatrist from your available podiatry limit under your Extras cover.
It is important to know that if your podiatric surgeon is NOT accredited for the purpose of paying private health insurance benefits, then CBHS will only be able to pay a benefit under your CBHS Extras cover and no hospital benefit will apply.
Is the podiatric surgeon aware of what CBHS will pay?
Podiatric surgeons are aware that most funds do not pay a benefit under hospital cover for their services and should advise their patients of the likely costs that the patient will bear prior to treatment.
Will CBHS pay the Anaesthetic fee?
No, there will be no benefits for this service.
How do I know what my costs will be?
When you have received a quote from your podiatric surgeon, we strongly recommend that you contact CBHS to confirm what benefits you are eligible for. After discussing this quote with CBHS, you will be able to determine your out-of-pocket expenses before proceeding with treatment.