We are doing some research in gap cost and medical specialists. Our aim is to make out-of-pocket costs less confusing or surprising and give the power back to consumers.
If you’ve seen a medical specialist especially because of undergoing surgery in the last couple of years and like to help with our research please send me a PM, email me at money@choice.com.au or leave a comment here.
We’d especially like to know how your booking in process and first consult worked and when you found out about the out-of-pocket costs involved with your surgery.
If you are a GP or medical specialist yourself we’d love to talk to you too. Any email and phone conversations are of course completely confidential.
Yes I’ve seen several this year. I see an endocrinologist twice s Year snd charges are $200+ for follow up consult that lasts less than 4 minutes. Refund $50+
An oncologist - bulk billed.
A breast surgeon for breast cancer and consultation, a lumpectomy cost $3500 OUT OF POCKET. everything involved with the Breast cancer in women over 50 has cost heaps. I’ve had MRI’s annually+ for fifteen years and been bulk billed but had to pay $500 OPE. Same with bone scans, and EVERY test and biopsy and pre-op procedures totalled $7000+ OPE above top Medibank Private and that was up to and including hospitalisation and surgery.
I didn’t have chemo but radiation costs between $1500-10,000 for six weeks OPE. Through the private system. Breastscreen Qld asked me on diagnosis if I had private health cover and when I said yes was told I was lucky as I wouldn’t have to wait. But I think the private surgeons who volunteer at Breastscreen to tell patients of their diagnosis are preparing future patients like a marketing ploy.
I’ve seen a psychiatrist regularly and charge us $210 and Medicare refund $56. When we have reached the safety net I get most refunded.
I’d been to see an ortho surgeon in Southport and after a few minutes consult and even less exam dr said his charges were minimum of $1500 out of pocket expenses. He also said I had to have a coloured MRI with a particular Dr costing over $500 OPE. So I got a 2nd opinion. The 2nd ortho surgeon was fabulous. He spent 15 mins+ exam & consult. He then said he’d treat me like he would want other Drs treat his mother. There would be NO GAP and there wasn’t. Not for anything with that Dr. he also designed a special hip with a swivel for more flexibility than the basic design. I went back a few times to him since and all bulk billed.
Years ago I had a suspected cancerous mole and decided to have several moles removed and at the check up
After surgery the receptionist gave me an account for $3000+. For OPE. I nearly fainted and asked to speak to Dr re the charges. But receptionist refused so I explained I would not have had that surgery if I’d known the costs. I could NOT afford the costs but couldn’t return the “product”. It was hugely embarrassing so I agreed to pay a sum each week and after a couple of months Dr said he would credit the balance r owing due to misunderstanding.
My personal view of doctors and Medical testing companies in the private sector with a recently diagnosed cancer patient is they rub their hands together thinking about the money they’ll make knowing the patient will be extremely “vulnerable”. When diagnosed with cancer I was distressed. So having no idea of an oncologist or breast surgeon asking for recommendations first question is “Do you have private cover”. Lucky! Lucky for the medical
Team. Not lucky for the patient. They are about to get ripped off by the whole medical team because we don’t think we have time to get a second opinion, it is urgent to rid the cancer from our body or start treatment, and at the stage of diagnosis money is not an issue. It’s a prime time for vultures to circle. When I had a planned hip replacement I wasn’t happy with the initial surgeon and had a second opinion who did a better hip, bulk billed and was wonderful. Now I just showed up at breast surgeon and signed paperwork for surgery tests Etc and was told if out of pocket expenses and panickly went ahead with everything suggested blindly. Along the way in various waiting rooms talking to other cancer patients found that different Drs charged different fees for different people. And the public system seemed to be a cheaper but equally good system.
I really felt angry that after paying $430 per month for private health insurance and being aged pensioners I had to pay $7000+ for my breast surgery and the associated presurgery tests. And the fact that the original doctor I saw (the breast surgeon) never ticked bulk bill on any test request he ordered. Prior to this 95% of any MRI, bone scan, ultra sounds etc were bulkbilled. But I was continually told woman over 50 with breast cancer are not covered for this by Medicare or private health insurance. This also made me feel depressed and angry. I felt like the govt were cutting funding for tests Etc got women over 50 with breast cancer and those who couldn’t afford it would die. It was horrible. And unnecessary to have all of this added to the overwhelming diagnosis of cancer. Cancer is not a choice and it’s frustrating they drug addicts get free methadone and needles and safe places to shoot up, when drug taking is a choice and ILLEGAL yet the government fund it.
I regularly visit an specialists to treat coeliac disease and severe osteoprosis. I have had multiple endoscopies for which there has been no out of pocket expense and the gap (of around 1/2 the full cost) was fully covered by my private health insurance. The anaesthetic cost is usually not fully covered by Medicare and private insurance - usually out of pocket by around $80-$100 per procedure (I average about 2 a year). The out of pocket for visits to specialists’ consulting rooms is usually around $60-$70 per visit or less when I see the registrar instead of the endocrinologist.
For initial visits the out-of-pocket was, from memory, over $100.
Like others responding here, I also had cancer. And private health insurance. Even though the experience was relatively recent, it still feels like a blur. I never really questioned the referrals I was given - from a GP to a gastroenterologist, then to a colerectal surgeon and then to an oncologist. You’re certainly not in a position to think about other options and trust the advice you’re being given.
In relation to the surgery for bowel cancer, the out of pocket costs were explained by the receptionist and I also received written information (I can’t remember if this was mailed to me or given to me at the time or both). In any event, I knew there would be out of pocket expenses. These were over $1K for the surgery. There were lots and lots of other costs too for various tests, other doctors etc … I haven’t added them up as I’m not sure I want to know!
I had my cancer treated in the private system for 5 years until being transferred to the public ststem cause the drugs I needed weren’t on the PBS and Peter MacCallum Cancer Centre subsidized them. Both systems are amazing. After initially finding my tumour surgeon had gap fees $60 odd for consults and $750 for the surgery itself (I thougt this very reasonable for what he did, replumb my digestive system ), gastroenterologist for endoscopic ultrasound bulk billed, anesthetist $100 gap each (one ten minute procedure and one four hour procedure). Initial oncologist charged $1000 for a few consultations while in hospital (no gap paid by me Medicare and PHI paid, but such a wrought). Blood tests and chest xrays in ICU were $100’s of dollars. PET scan $800 and no rebate. Radiotherapy wasn’t too bad as I had reached the safety net by this stage. Non necessary chemotherapy drugs (don’t ask) $16,000!!! One year a liver biopsy and two nuclear medicine scans cost me $5000. Cancer is an expensive illness indeed. No I am in the public system every test, biopsy, scan and consult is covered and all I pay for is the PBS drugs.
@baznsan I have requested doctors to tick the bulk billing box when they have not done so. Every time they have done so, except when there is no possibility of bulk billing. Also, there is nothing stopping you from ticking the bulk billing box yourself. I have done this (even when the form is printed out via a printer) after realizing after the appointment that the doctor hadn’t ticked the box. And, when the procedures were done I was bulk billed.
Contrary to what some would have you believe, doctors are not demi, or even semi gods, they are just people. As such, there is a wide range of personality traits among the doctors from avarice to altruism as you have found.
The bottom line is everyone (like you are) needs to be assertive and take charge of their health care. People should not blindly and unquestioningly accept what a doctor says until they have proven their competence, compassion, and trustworthiness.
Thank you. Yes I have ticked the bulk bill box too on blood tests etc occasionally, but this was a whole new experience as o was continually being told Medicare do not fund this appropriately. I will certainly be checking everyone if these firms got tests in the future. I felt it was part of the plot to charge more for cancer because it’s an “opportunity” to go so by medical practitioners as the patient is extremely vulnerable.
Well done for getting a second opinion for the ortho surgeon.
In case of the surprise bill the Royal Australian College of Surgeons considers it “a professional responsibility of surgeons to obtain informed financial consent from their own private patients and to facilitate the obtaining of informed financial consent in relation to other practitioners involved in an episode of surgical care”. You could have also made a complaint to the Ombudsman on this matter.
Specialists can and do distance themselves from financial aspects through their office managers. Some office managers are really good about it, while others have a role to protect their employer from having to deal with patients excepting for those billable minutes during a consultation, and to assure accounts are paid and any legal requirements are ticked. In that spirit facilitating financial consent can be giving the patient a list of possible ‘other practitioners’ with their contact numbers. The care I received from two top surgeons (2 years apart and for unrelated things) was impressive, but the experience with their office managers and staff could not have been different.
An allied comment, my last previous experience was a routine day procedure under anaesthesia. I have some history with incubation tubes and discussed this with the anaesthesiologist before hand.
After the procedure my throat was raw and by the following day I was unable to talk. In lieu of being able to talk I sent a fax to the specialist’s office asking if the anaesthesiologist had to use a tube or if I should just see my GP. They called me in. The consultation, billed at the specialist’s full rate was a quick look at my throat, a proclamation it was probably severe acid reflux that sometimes happens and should get better in a week, but if not see my GP. I was not impressed with his business practices when they could have told me that on the phone, or just referred me to my GP. In contrast another specialist was going on holiday during my post-op recovery period and his boss just stepped in to look after me for whatever Medicare might or might not have paid him (private system).
Thanks for sharing your experience, Fiona - obviously in case of a life-threatening situation there is absolutely no scope for a patient to question or even negotiate out-of-pocket costs. This is one of the reasons why we are working on this topic. We think it is an important area were there is a real power imbalance between vulnerable consumers, health funds and medical practitioners.
Most of them aren’t even Doctors - they have a Batchelor of Science in Medicine - very few have the academic qualification of PhD.
That aside - a good ‘Doc’ is worth their weight in gold. A bad one, not gold. There was a time when the tribal witch-doctor held everyone’s fate in their hands - these days they are service providers and there are plenty to choose from. If they are rude or up themselves, walk out, don’t pay, and find someone who delivers the goods. I haven’t had to do that in quite some time, luckily I’ve found an excellent place where there are a few ‘good men and women’ who really deliver the goods.
I have just found that my Son needs an operation. The surgeon we were referred to is not a HBF provider so they will only give me $95.00 back and we will have to find a gap of $583.00. I am not very impressed, it seems to me that Australia is going down the track of the US were we are told which providers to use,
Considering it takes at least 10 years of study to become a specialist, it’s not surprising that they charge a lot.
What irks me is the miserable rebate you get from medicare. It’s based on a percentage of the “most common fee”, and this is set at the very low figure of $37.50 or thereabouts. How this could possibly be the most common fee iseyond me - that must be what the 1st years interns at public hospitals get paid by the hour.
At 84 I have ben paying into medical funds for over 60 years, as Family and the last ten years single, in working life I did not stop to question all the out of pocket costs for my family, but in the last ten years as a pensioner I have struggled to meet these out of pocket GAP expenses. About five months ago I opted out of paying for Medibank and now use the Public Hospital system which I have found wonderful. I have had many referrals from my Doctor for heart, eye, hip, shoulder, carpel, and ongoing cancer of the prostate, in all instances I can only say I have been most impressed with their courtesy and empathy for me and the individual problems. I am referred to three different hospitals for the various tests and treatments as a public patient, and all it has cost me is transport costs. T
ime in each case, including ongoing treatment has been no more overall than waiting for private Dr’s and Specialists including all the various tests, X-rays and MRI’s etc. etc.
All in all I would, based on my own experience, recommend that people find a good Dr that bulk bills, will answer your questions, recommend the best course of action, and in my case refer to (in his opinion) the best Specialist for the current problem at a Public Hospital.
