Prostheses overview

Prostheses overview

Information about surgically implanted prostheses.

 

Brief overview of changes to government approved surgically implanted prostheses

Latrobe Health Services covers 100% of the Commonwealth Prosthesis Listed benefit for prostheses when:

  • Prosthesis is provided as part of an episode of hospital related treatment.
  • Member has a hospital table of cover.
  • Medicare benefit is payable for treatment.

Following a review of the prosthesis listing process, changes will result in the grouping of prostheses and devices that have similar clinical effectiveness and deliver similar health outcomes. Once the groups are established a single group benefit will be set and all items will have the same listed benefit and there will no longer be a minimum benefit and a maximum price.

Potential impact of these changes to our members

It is expected that the vast majority of prostheses and device suppliers will accept the listed group benefit for their individual item resulting in no gap for the members to pay.

However the suppliers will have the ability to charge a gap on any item if they decide that the group benefit is insufficient and as there is no longer any maximum price set there is no limit on the amount of gap the supplier can charge.

The obligation for detailed Informed Financial Consent lies with the prosthesis suppliers, surgeons and the admitting hospitals. As there is no longer any maximum price, as a health insurer, we are only able to advise the benefit that will be paid and, as we have no access to the price and there is no control of the price that a supplier can charge, we are not in a position to advise you of the amount of gap you may incur.

Before you undergo any in-patient hospital treatment which will require the use of one or more prostheses, ask your doctor whether the prostheses he/she intends to use will attract a gap. You should also ask your doctor whether there are other prostheses available which do not attract a gap and discuss the reasons for your doctor's choice.

For more detailed information please refer to the "Overview of prosthesis changes" section or the "Fact Sheet" on this website