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When I was looking for double hip replacement surgery my GP gave me the name of a surgeon. I rang his office and was advised that his fee would be $5000. I then turned to the list of possibly cheaper surgeons on the website of my health fund (Defence Health). I plucked 3 names from the list and rang each office. I was able to get a quote of $500 for surgeon and $200 for the anaesthetist from one office. This quote included no additional charge from the surgeon for the second replacement and still $200 for the anaesthetist. My advice is to ask around…your GP is likely not in the know as far as surgeons’ costs…You do not have to pay outrageous fees!
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My wife’s youngest sister’s husband who lives in FNQ needed to have a double hip replacement a few years ago and unwittingly made the mistake of deciding to have both done together as he expected it would be a simpler and cheaper process.
Unfortunately he found out the hard way that there was no “daily double discount” with the surgeon, the anesthetist, or the grubby health fund.
The surgeon, the anesthetist and the private hospital all charged him around twice the price for a single hip replacement which is “somewhat understandable”.
But to really add insult to injury, his grubby. bottom-feeding “health fund” reimbursed him the same, or a similar amount, that he would received if he had two separate procedures.
That’s a shame Fred! I am sure there are many competent and non overcharging surgeons and anaesthetists around but the medical profession makes it very hard to find them. Yes, I understand that if we knew the top rated doctors we would choose them and that would not work but I see no reason why the fees of all medical specialists should not be readily available. Similarly I believe that any doctor whose competence is being questioned should not be allowed to practice except under close supervision. Sometimes it appears that the doctors say “no” and the government just agrees…we are left to use our own judgement, which cannot be enough since we know almost nothing about medical staff or practices and nobody can tell us because our GPs know little about specialist workings. I was very lucky to find a good surgeon and anaesthetist and be charged very little more than my health fund rebated!
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What people fail to understand is that the invoice is a request for payment. It is not a legally binding order for monies. It is therefore required to comply with common law in regards civil monetary interactions, which requires that requests for payment be fair and reasonable in their terms and conditions. I doubt ANY civil court would consider 2 days fair and reasonable, whether it be from a medical professional or a car mechanic. Remember, courts will take into account what stated (if any) terms and conditions are before delivery of service.
When faced with this type of demand, people just shrug and pay without really knowing what their legal status is.
If it were me, and I thought the demand was neither fair and reasonable, I would pay the required amount in what would be regarded as reasonable…say 7 days. This then leaves then service provider in a quandary…how to then recover the outstanding amount. The only redress is to refer the matter to a deb collection agency or direct to a court. Either way, the final arbiter is a courtroom.
I’d bet dollars to donuts that no debt collector or service provider will proceed to court for $250 when the conditions of payment are that shaky. The consequences of losing the case would be far costlier than winning. It is also important to keep in mind that in Australia, in relation to matters involving amounts LESS than $10,000, lawyers are not permitted to represent either plaintiff or respondent. Meaning that to argue their case, the anaesthetist him or herself must appear in Court. The playing field becomes level.
The big problem is that people FEAR legal processes and procedures…and this allows business, professionals and service providers to get away with unfair and intimidating tactics to get their money. Once you lose that fear, and are prepared to stand up for what is right, you’ll be surprised at how these bullies back down. They are as intimidated by courtroom appearances as you are.
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Thank you for posting this in the community.
This bill is an example of bad practice. On top of charging an extremely high late fee, it is very confusing and contains a major error
The anaesthetist has written the bill in a very confusing way: it says in the difference between 1249.40 and 749.40 is $750.60 which is wrong - it’s $500.
It also doesn’t make sense if you do not explain that the health fund’s gap scheme has been used and may breach health insurance rules for gap schemes
How gap schemes work
For privately insured services in hospital (like anaesthesia), Medicare pays 75% of the MBS fee and the health fund pays 25%. So as soon as the provider charges more than the MBS the patient pays an out-of-pocket cost, called gap.
To reduce the amount of the gap and reduce the number of patients charged a gap, health funds use gap schemes. Under these gap schemes, health funds pay more than 25% of the gap up to a capped amount.
Bill may be in breach of known gap scheme
The heading of the bill shows that the health fund’s “known gap scheme” has been used. Under the known gap scheme a provider can charge an amount up to the cap set by the health fund and usually can charge the patient an out-of-pocket fee of up to $500.
Therefore, if the anaesthetist charges the patient 750.60 - as they threaten to do if the patient does not pay $500 within two days after receiving the bill - they also have to give a refund to the health fund.
If they do not give the health fund a refund they may actually be acting illegally. It is also not in the spirit of a known gap scheme to not provide financial consent before the procedure and put the patient under pressure after the procedure.
Lodging complaints
I would suggest lodging a complaint with Commonwealth Ombudsman (PHIO) about the confusing way in which the bill is written including the potential breach of gap scheme rules.
If something similar happens to anyone else, the best first step is to call the provider and negotiate more time for paying the lower fee.
We’d also love to hear about it, please don’t hesitate to contact me on healthinsurance@choice.com.au
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Is that correct?
Small claims procedures and court procedures are different in every state of Australia. Are you able to state more clearly which state or states the $10,000 limit applies to, for which courts or authorities, and under what conditions?
EG
Victoria appears to have a $15,000 guide re professional legal representation for claims to be submitted to VCAT. There appears to be no lower limit or conditions on claims before the Victorian Magistrates court. There is an upper limit if $100,000
I don’t know all what the answers are. It just appears there is no one single answer. There may be the choice of arbitration or a formal court action. My understanding is that arbitration and mediation may be recommended. These options do not preclude an application to a formal court with legal representation.
EG
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I believe the amount for a small claim is standardised, but I could be wrong. It USED to be $10,000…but in making that statement I am evidencing my more senior years. Nonetheless my point remains that you DO have rights and it is largely fear and trepidation that prevents many people from having those rights enforced. You do NOT need a lawyer to dispute a small claim…and where the claim is relatively small it is on the plaintiff to decide if they wish to pursue it.
Although it may be open for a plaintiff or defendant to seek a formal hearing in a higher court where solicitors may be engaged, unless things have changed dramatically, I would be astonished if leave were granted to do so would be granted for a claim of a few hundred dollars.
I am no lawyer…but if I were presented with such an ultimatum, I would not bow to such unjust pressure. However, the first thing I would do as a matter of course is to contact the service provider and advise them their terms are unacceptable and that full payment will be forthcoming in, say, 14 days.
If matters do deteriorate to a legal process, that action alone will almost certainly save the day.
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Thanks for this comprehensive review!
It does appear to be worth lodging some complaints about this.
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While this individual case does have some shonky elements, I’m aware of a little background that doesn’t seem to be being mentioned in the discussion:
- The Anesthetist is the doctor least likely to be paid - at all!
** Which is why they have this thing of bonus-cheaper/penalty-cost - The Anesthetist’s role is vital - basically - he/she keeps you alive while someone else sticks a knife in you. It’s a far from simple role.
- A good anesthetist can make a bad surgeon look good - and vice-versa!
My experience of anesthetists is that they, like the doctor, will tell you what to expect, and inform you of discounted early payment.
Again, the above instance seems to have been poorly handled - the briefing on payments that I recall came not from the practitioner but from the office/receptionist level.
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While all reasonable points they have no bearing on the presentation of the referenced statement.
Medicare stiffs them? Or do you mean their above Medicare gaps that are the patient’s or funds responsibility?
They tell me what to expect from them during the procedure but the first ‘discussion’ of fees has been when I received their statements with the ‘discount’ date.
Reality is there is no discount for early payment, there is a penalty for less than immediate (or Very Timely) payment. Whether one calls it a discount or penalty can colour one’s view.
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Check the maths. 750 + 749.40 does not equal 1249.40. That specialist is rotting.
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I’ll just leave this here, the seem to be getting quite a bit of money from somewhere. Not that I want to downplay the importance of their job, but bills are being paid.
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No, the patient stiffs them. So I’ve heard on several occasions, over the years. Surgeon gets paid but anesthetist does not.
The originating complaint is valid; no argument. 50% mark-up is too much. 2 days notice is too little. etc. Phrasing it as a penalty for late payment versus a discount for early payment - all bad admin and patient relations. No argument.
But the origin of late-penalty/early-discount came from a problem with people choosing to not pay their anesthetist. That was my core point and I’m now bowing out of this discussion.
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I have been down a similar track. And I had a friend who worked in the Anaesthetists peak body in Melbourne.
1 The peak body will do nothing about your complaint
2 They hear it all regularly the and encourage (push) for less of such behaviour. without success
Q1 - did you have a written and signed cost agreement with the Pirate ? sorry Anaesthetist?
If not then you pay the scale fee ONLY. there was no other contract No meeting of minds.
Initiate proceedings for relief of Debt in small claims court in your state - and watch Dr Pirate hit reverse gear. You won’t need to go to court she/he will back off well before that.
I don’t care if these people are demi gods or whatever status you give them. The same business rules apply to then as us mortals. Re read all of the above and substitute the word Anaesthetist with “car repairer” “plumber” or “JB HiFi” and see how you feel then.
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The article is paywalled.
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ah, seems to be ok if you come at it from google: “afr highest paying jobs”
Men
- Anaesthetist $370,492
Women
- Anaesthetist $243,582
That gap between the genders is quite depressing.
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The gap between the anesthetists and the rest of the population is even more depressing.
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Unfortunately this practice by anaesthetists is widespread, and has been for many years. I know from personal experience that it was already normal practice in 2001.
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I think you are all being a little unfair.
The anaesthetist has received a plumbers bill he has to pay somehow.
Common guys.
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