CHOICE membership

Have you seen a medical specialist?



I had surgery for a hernia is 2013. I was surprised to find after the fact that a foreign doctor who wasn’t registered for Medicare was involved in the procedure and I was not able to claim any of his expense on either Medicare or private health insurance.

Aside from that, I’m pretty sure the surgeon was upfront about the expenses and my health insurance company at the time, Peoplecare, were very clear about what expenses they were covering.


I had carpal tunnel release surgery earlier this week. The surgeon I went to had a $250 out of pocket expense and I was informed of this when I made the appointment to see him. That is all I paid on the day for both the initial consultation and surgery - I’m assuming the rest was bulk billed. The procedure was done in his rooms so no hospital was involved.


My daughter had dental surgery recently - was to be in the town I live in (no private hospital for a thousand miles in any direction) so it would have all been covered. We chose to have it done in Adelaide, for timing reasons and we happened to be there. Everything was covered except the Anaeth - he was a couple hundred out of pocket - surgeon, hospital, etc all covered by medicare and private health, who had an agreement with the hospital.

What wasn’t covered were the CAT scans that “Dr Jones & Partners” (in crime?) did. more than all the rest put together - because the surgery was dental, Medicare didn’t cover it and neither did private health (even on top cover).


One thing I don’t understand about my private health insurance is why I can claim for somewhat “fringe” therapies like Feldenkrais and naturopathy but I cannot claim anything for a consultation with an ENT specialist, an actual doctor! BUPA has not been able to explain this to me.


It is amazing BUPA could not tell you that private insurance is not permitted by law to pay benefits towards out-patient medical services where a Medicare benefit is payable. Since an ENT is a doctor, Medicare benefits are payable. “Fringe” benefits that vary from cover to cover do not have a Medicare benefit so private cover can pay toward them.


Two points that may be of interest…

  1. My husband and I elected not to have private health insurance. We just pay for private specialists on a user pays basis when we need them. This served us well for many years. However we got caught out when my daughter needed to see a specialist for a surgical consult. We did our research to find the surgeon we were happy with only to find that he had a policy not to see anyone who didn’t have private health insurance. Even though we had the cash available, and were willing to pay in full in advance, his staff advised that he would not be able to see our daughter. I made some more phone calls and found a couple of other surgeons in the area doing the same thing…

  2. I have seen the same private dermatologist every year for over 10 years now, after getting skin cancer. As I haven’t had private health insurance, I been able to pay in full each time. No problem. I have just needed to have a current referral from my GP. My annual appointment is next week, and I just found out this week that my ‘open-ended’ referral expired two weeks ago. I had to go to my GP yesterday (Saturday was the only day I could get in on short notice) just to get a new referral written. A waste of my time, and the GP, just to put a new date on a letter that was already in the system at both ends.


My husband had tightening on his chest - our GP sent him straight to the public hospital with a letter. He was admitted immediately and it was determined he needed a quadruple bypass. As we had full private insurance with Defence Health he was transferred by ambulance to the private hospital where he was operated on and recovered over a 10 day period. The care he received was exceptional and the only out of pocket expense was the hospital car parking charges when we visited him! I can’t speak highly enough of the doctor, nurses and Defence Health!

However visiting a gynaecologist for a routine Pap smear cost $330 and Medicare refunded only $72! Surely it is time Medicare reviewed these paltry refunds.


I saw a specialist approx 20 months ago and found out the excess was a touch under $5000 for a heart surgeon and an an anaesthetist. I found out, after I had been transported from a regional hospital to a Melbourne hospital, a couple of days prior to a triple by-pass. There was no excess for the specialist who controlled the blood and air flows. In a separate issue I’ve had a couple of MRI’s with no out of pocket, an oncologist with no out of pocket, Sleep specialist I think was about $150 out of pocket, a hernia operation also was only approx. $200 out of pocket.


I agree completely. My mother paid ‘health insurance’ all her life - for over 70 yrs then when she had to go to hospital she was put into the Public System (being nearest).
I am a pensioner now and go the the public doctors and hospital - never had better treatment. Especially dental - the public system fix what you go in for ONLY and don’t
find a million others reasons why you should keep coming back for things they THINK you need done!


Thanks for all the contributions and advice everyone has shared in the Community, we appreciate it. We’ve recently published @UtaMihm’s article on the medical gap costs, which calls for greater transparency on out-of-pocket fees.


My wife recently saw a specialist in the private system (Endocrine). The cost on asking was reduced to Bulk Billing though we were happy to pay if it was rejected as a choice. From now on they will continue to Bulk Bill us. It should not be seen as rude/improper to ask if a cost can be reduced but I think many feel that it could be seen that way.


My Mrs was sent to see a specialist concerning her allergies and after a couple of visits, she’s not really sure why she’s even bothering considering it’s costing us hundreds of dollars at a time just for the specialist to briefly look up her nose and then say to make another appointment because he can’t do anything while her sinuses are playing up, or because she has a cold, or she has hay-fever or some other reason to put off any actual diagnosing until another day. Even though nothing ever gets done and she’s out within 5 minutes, she still gets charged the same overpriced fee as if the visit was beneficial to anyone other than their accountant.