Your Estimated Gap
The known gap amount you have been quoted which is payable prior to surgery is:
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Amount Payable
Surcharge
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Price:
$ 0.00
Total amount to be paid including surcharge
Total amount to be paid including surcharge
$ 0.00
Informed Financial Consent
The amount you are paying today is our estimate of your out-of-pocket costs. The bulk of the fee for this service will be paid directly to the provider from Medicare and your health fund. Your known gap estimate of fees was prepared with the understanding that you hold private health insurance, that your policy is up to date, and that you hold an adequate level of cover for the services that are to be provided. If for any reason your health fund rejects our claim, you will incur additional costs. Our estimate does not include hospital fees, or fees for services provided by any other medical practitioners involved in your care.
*
The amount you are paying today is our estimate of your out-of-pocket costs. The bulk of the fee for this service will be paid directly to the provider from Medicare and your health fund. Your known gap estimate of fees was prepared with the understanding that you hold private health insurance, that your policy is up to date, and that you hold an adequate level of cover for the services that are to be provided. If for any reason your health fund rejects our claim, you will incur additional costs. Our estimate does not include hospital fees, or fees for services provided by any other medical practitioners involved in your care.
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