Hi, my daughter turned 17 in September and has been experiencing anxiety I took her to the gp. We were charged 80 dollars and reimbursed 36.50 from medicare. My daughter was told to go have blood tests and come back for follow up.
We were charged 80.00 again today on the 2nd appointment and my daughter needs come back again in 10 days, will I just keep being charged 80.00 everytime? .
We do get the rebate of 36.50 I asked the practice manager what the charges were for and she’s said it was to read the blood test results and health care plan. I thought ongoing follow up consultations after 1st visit would not be any extra fees. I’m worried about having to pay 80 every visit, as my daughter will be having follow up appointments with this gp.
My own gp doesn’t charge me extra to read my blood test results, I’m just wondering is this normal. Thankyou for help.
Hi @Sea10, welcome to the community.
GPs fees aren’t regulated in Australia and as a result, a GP can set their own fees in relation to a standard consultations like your daughter is having.
Some GPs chose to only charge the Medicare scheduled or prescribed fee, and this is what is called bulk billing. This means when one sees a GP that bulk bills, the patient isn’t out of pocket as a result of the consultation.
Other GPs chose to charge fees above the Medicare prescribed fee, this is what your daughter’s GP is doing. The GP choses to charge $80 per consultation and the patient needs to make up the difference between the Medicare prescribed fee and what the GP charges…about $45 in the case of your daughter’s GP.
Doctors can also decide how fees are charged. Some might charge above the prescribed fee for the first consultation for an ailment, and then reduce fees for follow ups for the same ailment. Other may chose to charge their standard fees for every consultation, irrespective of it is a new consultation or follow up.
In relation to why GPs charge above the prescribed Medicare fee, this is something to ask your daughters GP. It could be that their practice has higher overheads (rent, insurance, personnel for other services, administration staff etc) or the number of patients in the area is low meaning the fixed operational cost is spread amongst a smaller number of patients.
When deciding on what GP to use, one should consider a range of things including out of pocket expenses and how the GP practice charges for follow ups (including discussing test results), writing repeat prescriptions etc. One can in effect ‘shop around’ to find a GP which best suits one’s needs (location, time appointments are taken, out of pocket expenses, time to get an appointment etc).
Assume that the GP you accompanied your daughter to is not your GP?
There are GP’s who offer bulk billing to all or many of their patients. The experience of our children when in their late teens or early 20’s and still students or casual/low incomes is it pays to ask in advance. It often makes a difference if they make a booking or mum and dad.
Ones ability to shop around for a GP depends on where one lives. For those living outside Australia’s urban sprawl, the options are more limited. Medicare does little to assist with the higher costs of GP’s outside the big smoke. Health outcomes are not equal or equally affordable for all depending on where one lives. It’s ‘The Australian Way’!
Is there some reason you did not take her to your known GP?
We have a few very good bulk billing clinics locally, but most non-bulk billing GPs are charging around $85! Family experience with one long term non-bulk biller has been that the GP was happy to give results on the phone at no cost.
It is also the case that some GPs, usually at non-bulk billing clinics, do not routinely and automatically tick the bulk billing option for tests. In other cases the GP is registered with some pathology offices but not all, even from the same company - so go to location A for the test and it might be bulk billed, but go to location B and there will be a (sometimes significant) charge since they cannot bulk bill for the particular GP who is not registered with them. We only found out the latter on questioning. Yet another opaqueness of ‘the system’. Nobody volunteered the information until a family member was trying to get in sooner than later and rang a few offices, and one had an opening - but when the GP name was offered it was only then they revealed they could not bulk bill for that GP. The GP never made mention over years and it was just accidental we always went to a ‘registered’ pathology office.
Though you do not need to use the pathology service noted on the form. Now regardless of the form you can use any service you choose. The old system was a bit of a pain, and Drs may have registered with particular providers but now it’s much more open. This openness also applies to x-rays, ultrasound etc.
The pathology collection in the doctors surgery in our local shopping centre has a sign in the window advising that they accept all referrals.
Seeing that it is Sullivan Nicolades, I don’t know what other referrals they may come across.
Thanks for explaining, I was under the belief that follow up appointments for same condition were no further charges.(obviously I was wrong) This Dr is in the same practice as my gp who I’ve seen regularly for years but he is booked out. My daughters anxiety and panic was pretty severe so I opted for seeing this other Dr who she could get an appointment with quickly. (same practice) I live in regional Qld, my closest practice isn’t accepting new patients and we drive an hour to see this one. I’m just trying to figure how I can budget my daughters care, as there’s prescriptions, psychologist and now gp ongoing costs. Next week she goes back just to check she’s feeling on her medication, and then every month. Thankyou for reply.
Her blood test was at QML a separate business to the gp, and there was no extra charges from them. This Dr is in the same practice as my Dr who has never charged me extra fees as he sees me for an ongoing spinal issue, I just recently had bloods and he didn’t charge me extra to read them to me. That’s why I was confused.
I couldn’t get an appointment for my daughter with him, she had a panic attack and anxious and I was offered this Dr instead who could see her quickly. So with my daughters prescriptions and psychologist referral, there will be ongoing expenses, my daughters going back to this Dr in 10 days just to check she’s feeling OK on the medication, I’m just hoping that it’s not 80 everytime. I’m just trying to get some transparency on costs and how to budget for this. Thankyou so much for replying.
That is correct, it is just how bulk billing ‘responds’ to this or that location for a particular GP. The experience I recounted was only a few months ago.
The biggest surprise was that different offices of the same pathology company responded to bulk billing requests from the same GP differently. A few bulk billed as requested, and others would not.
Yes she’s in school grade 11, and we live in regional Qld. The blood test was done at QML no charges it was bulk billed no extra fees. I just wish there was easy transparent way to budget the cost as my daughter needs prescriptions now and a psychologist appointments and regular reviews with the Dr. Thankyou for reply.
Seek to get a Mental Health Care Plan from the Dr for your daughter as this will allow her to get at least some of her psychology cost met by Medicare for about 6 sessions though it may still be the increased COVID-19 limits which I think are 13 visits. Sorry my numbers were wrong it is 20 visits currently
This gp is in the same practice my own, he doesn’t charge me extra. I couldn’t get my daughter in with him quickly so saw the other Dr.
Yes we have done that, thankyou, very grateful there’s some assistance with that cost I think.
Many (most?) clinics are shared facilities rather than businesses per se. The GPs share costs for the rent, reception, nurse, and whatever equipment they have. The GPs in any given clinic usually have the same rates for a consulatation, some might bulk bill in specific circumstances but not all will, and some might be more or less generous case by case. Each GP can usually do whatever they want within the confines of their agreement with the clinic ‘management’. Oft times the GPs are not the management, they are roughly equivalent to contractors or renters.
The clinic I attend starts with ‘Our independent doctors …’ if that helps make the point. They can all see one’s clinical records on their screens but each has responsibility for their own ‘business’.
Ring around and find one who will either Bulk bill the visit or one who is close to that. I am sure there will be several who while they won’t charge you a lot will provide a very good service. Perhaps asking your friends might get you some recommendations.
Is your daughter on any Govt benefits eg Austudy, JobSearch or has a very low income? If so she may be able to get a Health Care Card that will reduce the cost of PBS scripts to around $7 each.
There is the Medicare Safety Net which has 2 tiers the first when $482 in fees above the Medicare rebate have been paid, the other when over about $2,200 has been paid in a year above the rebate. This is automatic and means even at the first level a decent higher rebate being paid. A Govt concession card eg a Health Care Card (HCC) will reduce the limit for the extended safety net you have to reach before getting the benefit, another reason perhaps to check if eligible for a Card.
Thanks Phil, it looks like its just up to the Dr if they charge extra fees then. I thought as both Drs were in same practice they’d be charging similarly. I might on reflection speak to the practice and change my daughter to my Dr whom I’ve not had extra fees, he’s always bulk billed things like reading a blood test. I just have to consider financial transparency as my daughter will be having treatment for 12 months and see a psychologist there is a health care plan but there will be ongoing expenses with that too and ongoing check ups with the dr. It soon all mounts up so far the last 2 weeks has been 160 on dr and 86 on prescription. The psychologist is 209 a session and after reimbursement with the health care plan its going to be 80 out of pocket as well, urgh its all adding up. Obviously I just want my daughter to get well, I just trying to figure out the costs, thanks.
Hi Graham Yes we have a mental health plan, the psychologist said its 209 per session after reimbursement from the plan, my out of pocket is 80 per session.
I understood that you had a plan from your previous reply to me. Sorry if it seemed I didn’t understand.
Based solely on your out of pocket for the psychologist you would reach the first safety net on Medicare after 6 visits, adding in the Dr’s out of pocket you may reach it much sooner. The safety net resets each 1 January so depending on the number of visits this year it may not happen this year but it is likely to happen in 2022.
For the PBS safety net if not a concession card holder, it will take a lot longer. This late into the year it probably won’t be reached but next year it is possible.
We’re out of the city in SE Qld and understand the issues of access. We both retain our respective GP’s who are not local. Both practices and the GP’s will follow up results by phone. Both will also as far as is practical provide Telehealth consultations. It’s convenient for renewing medications and meeting other needs without travelling.