Fees and payment

Most private hospitals do not employ anaesthetists, just as they do not employ surgeons. Instead, anaesthetists (and surgeons) are self-employed and usually invoice separately. So the total cost of your surgery is the sum of the hospital fee, the surgeon's fee and the anaesthetist's fee.

10 of our 25 consultant anaesthetists are not fee assured. They remain on pre-2010 contracts with various private medical insurers (PMIs). These contracts recognise the right of the consultant anaesthetist, as an independent practitioner, to set their own fees. When this is the case, you pay the shortfall between your insurer's maximum and our self-pay fee.

Insurers are continually trying to push down their costs while costs are steadily rising, so unfortunately shortfalls are steadily increasing.

This can happen for two reasons:

1. A very short operation (under 10 minutes) that still needs a full general anaesthetic.
2. Insurers are cutting costs and reducing what they pay surgeons by requiring all surgeons to be fee assured. If an anaesthetist who is not fee assured works with a fee-assured surgeon, the total anaesthetic fee (the insurer's anaesthetic maximum plus the shortfall) can occasionally be more than the surgeon's fee. This is a consequence of insurers running a two-tier contract system for their providers.

Many patients expect insurers to pay a reduced fee for our services. They may be surprised that the fee insurers pay us can be as low as about 35% of our list fee, which is why the shortfall can be significant.

Over the last 25 years many insurers have:

1. introduced mandatory fee assurance for new anaesthetists
2. run a fee schedule for anaesthetists that has fallen far behind inflation.

We rely on shortfalls to pay our anaesthetists market rates. Without them we would not be able to provide anaesthetic cover, and you would face delays to your surgery. There is currently a national shortage of anaesthetists: FAS has been running at full capacity for the last 24 months and has only recently been able to recruit more anaesthetists.

We only charge a shortfall where we are contractually allowed to.

More and more anaesthetists are ending their contracts with the major insurers because of the low rates they pay for anaesthetic services. If your anaesthetist is not under contract with your insurer, you will need to pay our full anaesthetic fee before your surgery.

Your surgeon has chosen FAS for the excellent patient care and service we offer. We are not able to allocate anaesthetists to operating lists based on patients' insurance. Some patients are reimbursed our fee by their insurer after surgery, so please contact your insurer to check.

We get regular calls from patients asking this. FAS has a bespoke fee agreement with Bupa, which works in the same way as being fee assured with Bupa, and all our consultants are recognised by Bupa.

Your surgeon asks FAS to cover their operating list. All our consultants work in the NHS, and our rota is built around their NHS and other commitments. We finalise the rota for the following week at Friday lunchtime.

If you would like to know which anaesthetist has been allocated to you, please phone the office and we will email you on the Friday afternoon of the week before your surgery.

We will send you a quote showing all the codes that might apply. After your operation, the invoice is adjusted to reflect the codes actually used.

Many insurers consider that the following procedure codes do not need sedation from an anaesthetist: A5230, A7302, W9030, W9035 and X3750. If your insurer declines to pay for anaesthetic cover, you will be liable for the full amount. We strongly advise you to contact your insurer and ask specifically about anaesthetic and sedation cover.

In our experience, insurers often say that a procedure is fully covered. Please check what your insurer will pay for each part of your procedure, including the anaesthetic.

Our fee depends on your operation, how long it takes and the anaesthetic you need. Anaesthetic fees are separate from your surgeon's and the hospital's fees. We send you a quote before your operation.

Before your surgery you may receive a quote for our fee through our billing software, MidexPro. It comes as an encrypted email from our billing email address, and we also send a text message to let you know a quote has been sent. Please look out for that email.

Our fee covers:

• an on-the-day preoperative visit
• your anaesthetic, which may include sedation, a general anaesthetic, a spinal anaesthetic and any nerve blocks you need
• prescribing your pain relief and anti-sickness medicines
• your care after the operation
• overnight on-call care if you stay in hospital
• transfer to another hospital in an emergency

Some self-pay patients are covered by a hospital package that includes our fee. In that case we collect our fee directly from the hospital, and you don't pay us separately.

If your hospital package doesn't include our fee, we will send you an invoice after your procedure for full payment.

Some insurance policies cover our fee in full. Others pay only part of it, and you are expected to pay the rest, known as the shortfall.

You are responsible for checking with your insurer how much of the anaesthetic fee they cover. Please contact them before your operation, and check their published fee schedule using the links on this page.

A shortfall is the part of our fee that your insurer doesn't pay. As the person receiving our care, you are ultimately responsible for paying our whole fee if your insurer doesn't pay for any reason. Once we know how much your insurer has contributed, we will send you a shortfall invoice for the rest.

Ask your insurer, or use their online fee schedule search: Bupa, AXA Health, Aviva, Vitality and WPA. Your surgeon or the hospital can tell you the procedure code for your operation.

If we don't have your correct details, such as your policy number or authorisation code, we may get in touch with you. Insurers won't process our invoices or pay our fee without them.

Because of data protection law (GDPR), insurers won't give us information about your policy or claim. That's why we sometimes need to ask you for details, or ask you to contact your insurer yourself.

Please email us or use our contact form. Include your invoice number if you have one, so we can find your account quickly. Our office hours are Monday to Friday, 9am–4pm.