SchemeBookUnderstand the system. Know what to ask.

SchemeBook / Costs

Plan for care and costs

Find out who provides care, who may bill you, what cover applies and what remains uncertain. This guide does not provide a quote.

1. Identify the care

Ask what consultation, test, medicine or procedure is proposed, where it will happen and who provides each part. A specialist visit or admission may involve separate accounts.

2. Identify the funding route

Are you paying privately, using a registered medical scheme, using another insurance product, or receiving public care? Your particular benefit option and registered rules affect scheme payments. Public facility fees can depend on circumstances and province; confirm locally.

3. Ask before planned treatment

Clinician

Ask for the proposed service, likely codes, a written estimate and other professionals who may bill.

Facility

Ask what its estimate includes, which accounts are separate and what happens if care changes.

Scheme

Confirm your option, network or designated provider, PMB assessment where relevant, authorisation, limits, scheme rate and possible member payment in writing.

4. Check the account

Keep the estimate, authorisation, invoices and claim statement. Ask which code, provider, tariff or rule explains any difference. Authorisation can carry conditions; it is not an unlimited promise to pay.

A typical journey

  1. For a specialist assessment, ask about referral, consultation fee and public care route.
  2. For a test, confirm facility, provider, codes and separate charges.
  3. For an admission, get a facility estimate and written scheme benefit response.
  4. After care, compare every account with the written answers.

Public patient fee schedule

SchemeBook indexes the National Department of Health's dated UPFS publications. These are public tariff documents, not a personal bill, private provider price or medical scheme benefit. Ask the public facility how the current schedule and your circumstances apply.

Check the National Department of Health publication page for later updates.

Sources and next steps

Council for Medical Schemes: PMBs · CMS complaints · Public care · Glossary. No Australian fee, Medicare or MBS data is used. Confirm individual costs with the organisations involved.