Preparing for your appointment
Do I need a referral?
You will need a referral from your general practitioner. You will need this to schedule an appointment, and please bring it on the day. This is a requirement of Medicare for you to be able to claim some of the costs of the consultation and surgery from Medicare.
When should I arrive?
If this is your first appointment with Dr Neela, please come ten minutes early so that you can fill out the registration forms.
Please make sure you allow time for parking, and do phone ahead if you are running late. Dr Neela always tries to make allowances, but please be aware that if you are late, you may have to wait for her to fit you in between other patients who have arrived on time.
What should I bring?
You will need to bring with you
- A referral letter from your GP
- All X-rays, scans, nerve studies and test results
- Your Medicare card
- Your Veterans’ Affairs card, if applicable
- Your private health insurance details
- A list of medications that you are taking
- The names and contact details of any other relevant doctors you might be seeing, such as your cardiologist, neurologist, rheumatologist or pain specialist
- Payment (we accept cash, EFTPOS and credit card)
- You are very welcome to bring family members, friends, and any written questions. Dr Neela will try and fit as many people in as you need or would like to attend
- Someone who can translate and interpret for you, if you think you need it
Do I need to bring X-rays, scans or test results?
It is essential that all test results are brought with you.
X-rays, CTs, MRIs
Dr Neela needs to see the images of all X-rays, CT scans and MRIs. If your GP or the radiology company tells you that they will ‘send the results through’, this is not enough. As a surgeon, Dr Neela needs to be able to see the images, not read the reports.
You will need to bring one of:
- Hard copy films – this is not the report on a piece of paper, rather the images printed out and in a paper bag
- Information as to the name of the company where the imaging was performed and how to access these images online – you can check with Dr Neela’s secretaries to see if Dr Neela has access to online images at the company where you had your imaging test done
- Please note that it is not usually possible to get immediate online access to X-rays, CTs or MRIs at your appointment if Dr Neela does not have online access to that imaging company, so do check in advance
Ultrasounds, nerve tests and biopsy results
You do not need to bring the images. For these tests, a written report is adequate. Please make sure that you get a copy of the report from your referring GP, or the doctor who did the test and bring it with you on the day.
What if Dr Neela is running late?
Dr Neela works very hard to avoid running late, but also believes that all patients deserve to have the time that they need. As the patients she sees range from having quite simple problems to very complex, sometimes it is hard to predict how long any consultation will take, even if a detailed referral has been provided. For this reason, we ask for your patience, and promise that you will also be given as much time as you require.
We will try our hardest to inform you if Dr Neela is running late.
What if I am running late?
Dr Neela does not believe in punitive measures if patients are running late. We understand that the traffic can be terrible, the weather inclement, the parking tricky, and that often elderly patients may struggle to walk fast. That said, every patient who runs late will cause delays for other patients throughout the day, so we ask that you be respectful and plan ahead so that you do arrive on time.
Please let us know if you can if you are running late (although please don’t touch your phone while you drive!), and also bear in mind that if you are late, you may need to wait until Dr Neela can fit you in between patients who have arrived on time.
What if I need to change or cancel the appointment?
As we have a waiting list of patients who require appointments, we ask that you provide 24 hours notice by phone if you would like to change or cancel your appointment. We do send reminder text messages, so we consider that it is only fair and polite that you let us know if you are unable to attend a scheduled appointment.
A full consultation fee may apply to those who fail to arrive without 24 hours notice. All patients do receive a reminder text message several days in advance, and have the option of declining a scheduled appointment.
What to expect at your appointment
Can I bring a support person?
You are very welcome to bring family or friends to your appointment, or both parents in the case of a child. Please also bring someone who can help translate and interpret for you if you feel you need it.
You can bring as many people as you like to the appointment, but be aware that we might struggle to fit your whole extended family into the room!
Write down any questions you may have so that you remember to ask them.
What happens in the appointment?
Dr Neela will review your referral, take a history and do an examination, and go through any test results you might already have. It might be necessary to perform further tests, which might be done on the day (such as a biopsy or an X-ray), or you will be referred for further tests and asked to return for a second appointment once these have been completed. Dr Neela may also be able to provide some treatment on the day itself, such as a steroid injection. We try our hardest to reach a diagnosis and treatment plan in a single visit.
Can skin cancers be removed on the same day?
Skin cancers which can be removed in the rooms may also be able to be done on the same day. The ability to perform a procedure on the day will be time dependent and it may or may not be possible depending on the complexity of what is required and the time it will take. If you are keen to have a skin cancer removed on the day, please tell the secretaries so they can schedule an appropriate time.
For procedures that are done in the rooms, you will generally be able to drive yourself home.
What if I need surgery?
If you need a surgical procedure, Dr Neela will discuss whether this needs to be undertaken in hospital or if it can be performed in the rooms. Dr Neela will explain in detail what surgery entails and what preparation and recovery is appropriate. You will be able to choose a date for the procedure.
Dr Neela operates privately at Epworth Eastern, The Bays Hospital and Beleura Hospital.
If you do not have private health insurance, Dr Neela will discuss options with you. She is able to put you on the waiting list for surgery at Eastern Health, and may also be able to offer you a surgical procedure in the clinic, or as a self-funded patient at a private hospital.
Dr Neela is one of few surgeons who is undertaking common hand surgery procedures such as carpal tunnel release, trigger finger release, de Quervain’s surgery, and removal of some ganglion cysts in the clinic. This can be a more cost-effective option for both patients with and without private health insurance.
Does everyone need surgery?
Dr Neela prides herself on her thorough and meticulous approach. She will not recommend surgery unless she feels it is in your best interests. She will provide you with as much information as you need in order to make an informed decision.
Fees and rebates
Dr Neela believes strongly in a fair and ethical fee structure which does not exploit or extort patients but reflects the cost of doing business and the expertise required to ensure the highest level of care for you. Her fees reflect this approach, and are set in such a way as to be accessible and fair.
Dr Neela will never
exceed the AMA Schedule of Fees for procedures
issue different invoices to you and your health fund
engage in bill splitting or other unethical practices
charge a ‘booking fee’ for a surgical procedure
exceed the ‘Known Gap’ limits placed by your health fund, even for long or complex procedures, subspecialised procedures, or joint replacements
have a fee structure which asks you to choose between different procedures for the same condition on the basis of different costs
Dr Neela adheres to the Royal Australasian College of Surgeons Code of Conduct, with particular regard to Section 7 Commercial and Financial Dealings, which can be found here.
Consultation fees
Please be aware that you will be expected to pay for the consultation on the day. We accept cash, cheque, Eftpos, Visa and MasterCard. We do not accept American Express.
Medicare rebates are a rebate to you, not a payment to treating doctors. Our fees reflect the cost of providing care to you in a private setting.
DVA patients are fully covered. Please bring your Gold Card with you.
WorkCover and TAC patients are fully covered if you have an active claim. If you are seeing Dr Neela as part of a Workcover or TAC claim, you will need to bring your claim number and other relevant details e.g. your Workcover Case Manager name and contact. Workplace and transport accident claims from interstate insurers are also fully covered. If you have not yet made a claim, then you will need to pay for the consultation and claim it back after. We cannot send a bill directly to the insurer if you do not have an approved claim. For steroid injections or any procedure including minor ones, prior approval must be given by the insurer, otherwise the insurer will not cover the cost. Dr Neela will help arrange this.
In order to receive the Medicare rebate, you will need to provide a letter of referral, usually from a GP. Letters of referral can be received from other specialists, but do be aware that referral letters from specialists are only valid for three months and may have expired before your appointment date, whereas referral letters from your GP are valid for twelve months. It is always a good idea to keep your GP aware of your ongoing medical needs and ensure that an appointment with a specialist is necessary, and for these reasons it is preferable to obtain a referral letter from your GP.
If you have seen Dr Neela previously, and are now coming back with a separate problem, then you will need a new referral letter in order to receive the Medicare rebate. Apart from it being a Medicare requirement, it is also good practice to see your GP first about new problems, as it may be something that can be managed by them.
Please speak to the secretaries with regards to the consultation fee structure. Pensioners, HCC holders and children are billed at a discounted rate.
Surgical fees
Out of pocket fees do apply for surgical procedures both in the rooms and in hospital, unless you are covered with DVA, WorkCover and TAC.
Why is there a ‘gap fee’?
The rebate for consultations and surgical procedures provided to you by health insurers and Medicare has not risen in many years, while the cost of providing care in a private setting to patients has continued to increase. This includes the cost of the premises, staff costs, and insurance costs. We do all we can to keep costs down, and as our fees are fair and ethical across the board, we are not able to offer further discounts.
We recommend that you discuss with your insurer why their rebate to you has not increased in line with the costs of your insurance premium.
What is the maximum out of pocket ‘gap fee’?
If you are insured with most health funds, your out of pocket surgical ‘gap’ will not exceed the ‘known gap’ limit set by your health fund. In general, this limit is currently $500, and so you can expect that your surgical gap fee will not exceed this. This includes long or complex procedures, subspecialised procedures, and joint replacements.
Different arrangements may apply to patients insured with NIB, please speak with us about this.
Dr Neela will never charge above the AMA Schedule of Fees for any procedure, nor does she engage in any unethical billing practices that have been highlighted (rightfully) by the AMA and the media.
Dr Neela works hard to keep fees at an affordable and ethical level. If you are facing financial hardship, please speak to your GP, or to Dr Neela.
Someone else quoted me x thousands of dollars for the same procedure. Why do they charge so much? Does that mean they are better?
We don’t really know why other doctors charge so much. We do know that egregious surgical fees have been highlighted in the media in recent years, and it makes us just as angry as it makes patients.
We do know that it is very possible to run an excellent surgical practice and not charge thousands of dollars out of pocket.
We also know that there is no relationship between how ‘good’ a surgeon is, and what they charge.
If you think someone is charging too much, or more than you can afford, or will not give a ballpark figure of their maximal out of pockets charges prior to an appointment, then there are no shortage of surgeons willing to be open and transparent.
DVA patients are fully covered. We thank you for your service.
WorkCover and TAC patients will be fully covered if their insurer agrees to cover the cost of surgery. There is an approval process that needs to be undertaken for each surgical procedure, even if the insurer has previously accepted liability for the condition. Dr Neela does not charge fees up front for WorkCover and TAC patients.
Pensioners, HCC holders and children are billed at a discounted rate.
Please speak to the secretaries if you need further guidance. The surgical gap fee structure is complicated and largely dependent on which health fund you are with and the complexity of the procedure required, but they will be able to give you some general information.
Patients without private health insurance
I don’t have private health insurance, but I still want to see Dr Neela. Is this possible?
Dr Neela works in public hospitals because she believes that it is important that patients have access to high quality care regardless of their insurance status.
Dr Neela is happy to see uninsured patients for an opinion, but there will normally be a fee for the consultation. She is then able to facilitate care within the public system, as appropriate.
For those patients who wish to seek care as a self-funded patient at a private hospital, Dr Neela can provide you with a quote, if appropriate. Dr Neela believes strongly in the importance of public health care. For urgent conditions, such as skin cancers or acute trauma, as well as for complex conditions requiring the use of plates or prostheses, Dr Neela will typically recommend care in a public hospital, because she strongly believes that Australians should not pay out of pockets for care that is appropriately covered by our universal health care system.
Post-operative fees and charges
Your surgical fees cover all post-operative care for six weeks. This does not include any hand therapy which you may require.
Hand therapy is a necessary adjunct to hand surgery; it is no different to needing physiotherapy following a hip or knee operation. In most cases, surgery without hand therapy will yield poor results.
Hand therapy may be covered by your health fund if you have extras cover, or there may be ways to access some Medicare contribution for this.
If you feel that you cannot afford post-operative hand therapy, then please speak to Dr Neela prior to booking for surgery. It is not possible to refer patients who have had surgery privately to the public hospital hand therapy clinics, however for patients who have surgery within the public system, then post-operative hand therapy is also covered.
Rural and Interstate Patients
We often receive appointment requests from patients in regional and rural Victoria, as well as NSW and Tasmania, and we fully understand that travelling for medical care is costly and logistically challenging.
Please let us know at the time of booking if you are travelling more than an hour to see Dr Neela, and also if you think that you might require surgery.
In the case of accidents and traumas, we can typically arrange a consultation and surgery on the same day or the following day. We will often ask that you send us your referral, a photograph or you X-rays, and all other information so that we can make a plan for you.
In the case of elective problems, including skin cancers and hand surgery problems, we generally exercise caution in booking surgery on the day of your consultation. The reason for this is that elective surgery is called elective, because it is something that you are choosing to undertake, and we want to make sure that you have time to make an informed choice, and understand the consequences. Even seemingly small things, such as the time you will be required to take off work, can be impossible to predict in advance, as this is dependent not only on the procedure itself, but on other health conditions you might have and on what you are required to do for work.
Similarly, it may not be in your best interests to undertake an elective procedure with less than 24 hours notice, as sometimes specific equipment must be ordered in, a specific anaesthetic is best, or the timing of post-operative care such as hand therapy is crucial. We don’t want to compromise when it comes to elective, non-emergency surgery.
With these caveats, same day or next day elective surgery can sometimes be arranged on a case by case basis. Please get in touch if this is something you would like to discuss.
Preparing for surgery
Check with your insurer!
It is helpful to know what level of cover (bronze, silver, gold) you have before you attend your appointment. Even with this information, it can be hard for us to determine if you will be covered for the surgery that you require.
Medicare and private health insurance funds code all operations by a five digit number called an ‘item number’. Our secretaries will not be able to provide item numbers prior to the consultation, as these numbers are highly specialised for individual procedures.
Once you attend your appointment, you will immediately be provided with the item number(s) that will be applicable to your procedure. We strongly encourage all patients to call their health fund immediately and check that they are covered. Due to privacy laws, we cannot check on your behalf. The private hospital where you will be having your surgery can and do check, but typically they only check on the day prior to your surgery. Many patients have been caught out unable to have scheduled surgery because they didn’t check themselves! Please check.
You may have an excess of your health fund. This may be waived for children, or if you have already had surgery in the last year (some health funds classify the year as January to December, and others from July to June). We cannot find out if you have an excess on your fund, how much it is, or if it will be applied. Please check this also.
Surgical Fees
Dr Neela does not believe in charging you thousands of dollars up front for surgery. If you have private health insurance which will cover you for surgery, we will charge you only any out of pocket costs, and will obtain the balance from your insurer and Medicare.
If you do not have private health insurance and are having surgery as a self-funded patient, then you will be charged the full fee up front, and can obtain a rebate from Medicare after your surgery is complete. We will provide a final receipt after your surgery so that you can claim the rebate; this cannot be done prior to the date of surgery.
If you are insured with NIB, please discuss this with the secretaries at the time of making your appointment. Patients insured with NIB may have to pay the full surgical fee up front.
Anaesthetic Fees
Anaesthetists are specialist doctors who have trained for many years to be able to keep you comfortable and safe during surgery. Thank goodness the days of patients having to bite on silver bullets is gone! A skilled, safe anaesthetist can ensure that you are comfortable, safe, and recover quickly, with a minimum of issues.
Anaesthetic fees are based on the time it takes to undertake an operation, and Dr Neela works with a number of anaesthetists who have slightly varying fee structures. You will be provided with the name of your anaesthetist at the time of booking the procedure, and they will all provide you with a quote based on the estimated time it takes for the procedure. This fee may change if your procedure takes less or more time than expected. Our time estimates are accurate the vast majority of the time.
Your anaesthetist may contact you by phone prior to surgery, especially if Dr Neela has identified specific health issues that the anaesthetist would like to discuss. If not, you will meet them on the day of surgery.
Fasting instructions
Fasting will be necessary for all procedures in hospital. You will not have to fast if having a minor procedure in the rooms.
Detailed and personalised instructions will be provided when you book in for surgery, but in general
- Please do not consume any food for six hours prior to your admission time. This includes lollies and chewing gum, as the very act of chewing will make your stomach produce fluid and acid. You may have a light meal up to six hours prior to your admission. Heavy foods such as meat, cream or fried foods can stay in your stomach for longer and make your anaesthetic unsafe, so please avoid these.
- You may have clear fluid up to four hours prior to admission, but only sips please. This includes water and any fluid you can see through if you hold it up in a glass. Pulp in juice and milk in tea and coffee counts as food, so you cannot have these.
- Please do not consume alcohol prior to surgery, and avoid smoking if you can.
Medications can usually be continued as normal. You can take these with a sip of water. If you are taking diabetic medications or blood thinners, specific instructions may apply.
General comments about surgery in hospital
There is a saying that day surgery is called day surgery because it takes all day!
We try and make it clear to patients where they are on the list, but note that this may change. Young children and patients with diabetes may need to go ahead of you.
The hospitals try to stagger admission times to minimise your wait, but they also have obligations to complete paperwork and check you in correctly, so most people will experience a wait.
Please bring something to read, watch or listen to. Do avoid bringing valuables that you do not need.
If you are having an anaesthetic, even just sedation, you will still not be able to drive home. You will need someone to pick you up, and it is preferable that you have someone in the same house as you the first night after surgery. This is because the effects of anaesthesia can last 24 hours. There is also a risk of bleeding after any surgery, even minor surgery, and it is hard to manage possible issues on your own. Please arrange for a family or friend to stay with, or stay with you.
After your surgery
You will be told if your surgery is day surgery, or if you will have to stay overnight. The hospital will make sure that you are safe and comfortable to go home.
You will need a responsible adult to collect you from hospital, and to stay with you for the first 24 hours after surgery. We suggest that for 24 hours you avoid
- Driving a car
- Taking public transport
- Using machinery
- Undertaking heavy work
- Consuming alcohol or other drugs
- Making important decisions or signing legal documents
Even if you feel quite well, the effects of anaesthesia and pain medications do persist for 24 hours, or longer.
General effects of surgery and anaesthesia
It is quite normal to experience pain after surgery. You will be provided with instructions and possibly medication to help minimise the pin, but these can make you drowsy. Please use the pain medications that you need, but only as instructed. If you feel your pain is not controlled with the medications that you have been provided, then contact Dr Neela
This is common after anaesthesia, but should settle quickly. You will typically not be discharged from hospital if you are too nauseated to eat or drink. You may not feel like full or heavy meals after surgery and this is quite normal. Usually appetite returns to normal within 24 hours.
This may occur as a result of your anaesthetic, and usually settles within a day or two
- Bruising/swelling/pain at the site of any injection site
It is quite common to experience minor symptoms where a drip line was inserted or medication was injected, and can happen even with a very skilled anaesthetist. This usually improves after a few days.
Anaesthesia can cause you to feel tired, sore and achy in your muscles. This can last up to 48 hours and will improve on its own. Please rest.
It is possible that your ability to focus and concentrate may be affected for a day or two. Please rest and this will pass.
Instructions specific to your surgery will be provided by Dr Neela before you leave. You will also be provided with instructions as to how to contact her in case of any issues.
