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What is a “Gap”?

A gap is the difference between what Dr Seeto charges and what you get back from both Medicare and your private health fund if you are privately insured.

What is a

“No Gap” scheme?

Where gap costs fall

“No Gap” scheme help image

This page covers the financial side of any consultation or procedure.

Some private health insurance funds offer a no Gap scheme for surgical treatments. This is where the private health fund sets the fee for the particular surgery and there is no out of pocket cost to the patient.

Informed consent not only includes discussion about your orthopaedic condition, the treatment options available and the risks and benefits of these options. It also includes financial consent, which are the costs associated with different treatments available.

What is Dr Seeto’s Normal Consultation Fee with a Gap?

Initial chargeMedicare refundOut of pocket costs
Initial consultationOther type of patient$300approx. $80approx. $220
Disability pension/aged pension cardlholder$240-$240
Subsequent consultationsOther type of patient$180approx. $40approx. $140
Disability pension/aged pension cardlholder$150-$150

What is “known Gap”?

Known Gap is where the surgeon charges a known fee above the level that is set by the private health fund. This is the fee which the patient will pay. Depending the health insurance company, the gap is usually $400 to $500 for Dr Seeto’s fee.

Not all insurance companies offer the “known Gap” scheme.

What is “known Gap”?

Does Dr Seeto participate in Known Gap?

Yes Dr Seeto participates in the Known Gap scheme if it is offered by your health fund. This, however, is determined by the complexity of your case as well as the complexity of the surgery required.

Does Dr Seeto participate in No Gap?

Unless there are extenuating circumstances, Dr Seeto does not participate in the No Gap scheme.

Is the “known Gap” different for different operations?

No, the known Gap is the same for different operations.

The known Gap however is different between different insurance companies.

What if I do not have private health insurance?

Dr Seeto looks after all patients irrespective of health insurance. The options available to you if you have no private health insurance are:

Surgery in the public hospital

  • Consultation Fees - checkmark iconThere is no cost
  • Consultation Fees - checkmark iconThere is a waiting list which can be 6-9 months
  • Consultation Fees - checkmark iconDr. Seeto trainees may assist or perform parts of your surgery under his supervision
  • Consultation Fees - checkmark iconYour after surgery care will be in the public hospital clinic

Surgery in the private hospital

  • Consultation Fees - checkmark iconSurgery costs vary based on the procedure, equipment/implants needed, and hospital stay duration
  • Consultation Fees - checkmark iconThe waiting time is usually weeks as opposed to months
  • Consultation Fees - checkmark iconDr Seeto performs all the surgery himself
  • Consultation Fees - checkmark iconYour after surgery care is in Dr Seeto’s office
Knee background

Do you need a

Knee replacement?

Dr Seeto in affiliation with Medibank Private and East Sydney Private hospital, offers a program for eligible Medibank Private Members, to eliminate medical out of pocket costs for your Knee Replacement.

The program includes a pre-surgery preparation program, spending the minimal time necessary in hospital, as well as home rehabilitation if necessary.


Out Of Pocket

Knee operation

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