The Federal Parliament has started an inquiry into the out of pocket costs and affordability of Australia’s medical system.
There are many treatments and procedures available for free through medicare, however most of us will come into contact with the private system at some point in our lives (either through seeing a specialist who then performs a procedure in the public system, or doing an entire procedure through the public system, or maybe through allied health services).
We wanted to know more about medical costs and in our research have noticed that doctor’s fees (for procedures, rather than consultations) aren’t always very transparent or clear. We were very interested to hear a few stories of people bargaining for lower costs on surgeries.
So, we want to know more. Have you ever had an experience paying for private medical care (including surgery) where you’ve negotiated the price of your surgery, including the cost of your anesthetist? Please tell us your story below!
Let us know:
- The original quote
- What you ended up paying
- How you negotiated
This will help us start to think about how we talk about the costs of surgery, and how aware consumers are of these costs.
Thanks - Tilly, Policy and Campaigns Advisor (health insurance, travel and a few other things!)
Gall bladder surgery - It was virtually impossible to get a firm quote of the various specialist costs. I enquired about negotiating costs with the specialist and anaesthetist and was told “this is the cost, there’s no negotiation - if you don’t like it, go into the public system”.
I went to see a gynae for a procedure that involved 3 appointments. The initial appointment was $595 including the consult. The following 2 were $495 each. I had the first one and as a low income earner, I rang before my second appointment to ask if there is a payment plan so I didn’t have to put it on my credit card. The receptionist spoke to the gynea and got back to me. The 2 appointments were reduced to $359 each but there was no payment plan. I went to the 2nd appointment but found there was no improvement at all, so I didn’t go to the last one.
Thanks @DrSpock, that’s interesting because the Royal Australasian College of Surgeons has this document on informed financial consent which says:
- Believes that by providing information to patients in advance, the imparting of the likely
financial implications of the proposed treatment is sound ethical and professional business
practice. It indicates respect for individual patients and their rights, avoiding negative
perceptions of private medical practice."
“The College recommends that wherever practicable:
(a) information about fees and charges for proposed in-patient surgical services
should be provided to patients in writing;
(b) the surgeon obtain a signed acknowledgement of receipt of the consent from the
© there be an acceptance to pay the fees disclosed.”
It’s one of those situations where they say the right thing, but in practice it doesn’t happen. They were very blaze about the costs and the written information I got listed the standard charges with a disclaimer that said “this is an estimate only, any number of things could happen and we will charge accordingly - if we need to bring in another doctor/helper/assistant they’ll charge whatever they like and you accept this”. It’s quite difficult even getting a picture of what the costs might be, you have to be really insistent. I can see how more vulnerable people, older people and the like just give up and believe everything they get told.
Luckily for me my private health insurance actually covered nearly everything except the usual things, $300 out of pocket over about $30k of charges isn’t too bad. I got better financial advice from HBF than any of the doctors or anaesthetists.
Tagging in our health insurance policy experts @UtaMihm and @dangraham who will also be interested to hear people’s experiences.
I successfully negotiated with a surgeon and anesthetist for a knee cap operation. When i rang my health insurer, to ensure i was cover for this operation which was caused by an accident, I was advised to get the quote for the whole operation in writing before I booked into the hospital. I called many secretaries and the quotes ranged from…we take your credit card details and deduct the costs after the operation…down to $500 plus $280 for an assistant plus $250 for the anesthetist. This was the gap I had to pay. I received the quote and the specialist and anesthetist kept to it. This quote also included the follow up visit a few weeks after. I have heard many horror stories regarding this gap payment and as i have limited income I had to find a qualified surgeon who I could afford which was not easy. I live in he country and had traveling expenses to consider too. We do get a subsidy for traveling but one has o pay up front and then wait for a refund. This puts added stress on to finances. I was grateful for the health insurer advice…she also told me what to say to get the information.
Thanks for telling us about this penlexa2002 and well done - would you mind telling us who you are insured with? Wonder if anyone else also got good advice from their health insurer?
Credit Union Australia and I have only hospital cover though extras etc are available
Thank you! That is good to hear
Dr Spock, what are your concerns with the public system?
Well, when i initially had symptoms I went to Fiona Stanley (the local public hospital) who misdiagnosed it and sent me home with a diagnosis of “muscular skeletal pain”. I ended up with a staph infection caused by not diagnosing and treating it and 4 months in and out of hospital and 4 operations (3 failed keyhole and 1 successful open). It was only diagnosed correctly as gall bladder problems when I decided to go next door to SJOG (the private hospital) for diagnosis.
I’ve tried to negotiate with Cardiologists but got a negative answer from my first one “he has to employ tertiary qualified people in his practice”. The second one is $170 per consultation cheaper than the first but at $580, it’s still excessive. The gap for me was about $250 for this consultation. I have to wonder why the health care companies don’t use their muscle to step in and try to get reduced costs.
That superficially seems like a good idea but one only need look at the US system for an answer that is not all inclusive, but. While it drives down or controls costs, you get restricted to your health care company’s contracted providers. The reality is then that the health care company accountants get control over much of your medical care decisions by holding the financials in their hands.
The providers receive what they can negotiate for each service item with the health care company and make up their income by having the health care companies insured routed to them, and the volume from that. It changes the relationship where the surgeon may not be as happy to spend an extra minute with you because it is his own out of pocket, if that makes the point.
PS. Those companies with a preferred provider network with no gap service are essentially doing that.
I once worked in Workers’ Comp - in the Government regulator here in WA, primarily in negotiating fees with the AMA and other allied health bodies. As part of that I did a fairly detailed analysis of the AMA methodology for fee calculation and fee indexation. The latter of those was (and more than likely still is, though I haven’t looked for some time) very flawed and basically geared to maximise growth over time.
If you go back through history, the Medicare Benefits Schedule (MBS) and the AMA Schedule were once the same. there were no gaps. Over time, the different indexation methodologies applied by the Commonwealth to the MBS and the AMA increased the gaps between the Medicare rebate and what the doctors were being told to charge by the AMA. Of course, this compounds over time. (To be fair, the MBS methodology probably underestimated ‘true’ cost increases over time also, which exacerbated differences).
If you have someone to check out the latest on the fee methodologies, it might be a worthwhile exercise. They used to be published in the appendices of each fee schedule publication.
As for the insurers, they will do whatever is the least risky and most profitable for them. I guess that would be to charge gap fees rather than negotiate with the various hospitals and medical colleges, AMA and so on. That’s why a little leadership and courage from governments (of all persuasions) would be desirable!
Yes. Have negotiated more than once.
I should point out that I find the act of asking for a quote embarrassing.
However I asked my surgeon what it would cost to have a growth removed from my hand. He gave his fee and i pointed out that my cost would probably be more than just his fèe. He agreed that he didnt know and would get back to me with the complete cost. A week later he came back’ not with the cost but with an agreement that he and his team (anaesthetist, hospital etc) would accept whatever my insurance would pay.
Some years ago (perhaps 15) I asked my GP for a referral to 3 eye specialists since there was a danger I would lose my driving license as a result of lack of peripheral vision. I needed an eyelid reduction whatever that is called.
The first quoted my an out of pocket $1500 plus hospital and anesthetist fees but had no idea what they would be. The second gave me the same quote plus an option to do the procedure in his rooms for $550. The third looked at me and offered to do the procedure for the medicare refund since he felt with photographs he would be able to justify the procedure on health grounds.
As a general rule I have found that GPs and surgeons have no real grasp of the costs to patients of the procedures they propose. My GP if not checked will send me off for tests and scans that in my mind are no justified. He doesn’t have a great handle on the impact (both cost and time) that his tests will have. As a single example he asked me to get some scans and tests so that he could tell me if I was suffering from A or B. The process would have involved many visits to various clinics and an out of pocket expense just for the scans of $300. When I quizzed him on what the treatment was for A or B the answer was–there is no treatment for either. Obviously I didnt go for the tests.
Not that this will help your situation much but everyone should also be aware of a scam that specialists use with the initial consultation fee.
They will charge you an initial consultation fee when you first see them then the rate goes down for visits after that. After a certain time(say 6 months to a year) however they recharge the initial consultation fee. This is actually against medicare rules if it is for an ongoing condition. Including follow ups after an operation.
If any specialist tries this with you, explain you will not be paying another initial consultation as it is an ongoing issue. If they refuse, report them to medicare
I have never negotiated a bill with a surgeon or specialist, but two recent surgery experiences exposed a new fee ‘trap’, at least in NSW. In both cases, the surgeons charged Medicare and my private health fund, but in addition, I was required to pay an upfront fee of $500 which was not claimable from anywhere. I wonder if this is a ruse by surgeons to get around agreements with health funds to only charge the amount that is rebated by the funds and by Medicare?
Health policies have a hospital excess (policy dependent usually $0, $250, $500, or $1,000) that must be paid up front. Is the $500 you are referring to possibly a hospital exxcess?