I am not sure if this is a tutorial or a rant. Two in one?
I have found the medical costs finder less than useless. The cost finder is sparse and did not have the medicare item number nor anything related in textual searches.
Around Melbourne and probably elsewhere GP clinics post their routine consultation and services prices or will answer a question.
OTOH specialists seem to guard their fees beyond initial and subsequent consultations. However, ask a question using an item number and they instantly retreat into ‘that cannot be answered without an assessment’ mode. Their reluctance to talk about costs with a patient seems not to differ regardless if a simple routine, complex, or highly specialised surgery. In each case their forms indicate ‘things happen’ that can affect the final bill. They stay aloof from dollars and delegate that discussion to their office staff.
The process becomes
a) book a consulation with GP
b) pay the GP $$ for a referral
c.0) [in the private system] book consultation with specialist at $$$$
c.0) [in the public system] await a booking
c.1) get referrals for tests, scans, etc
d.0) [in the private system] book consultation for results at $$$
d.0) [in the public system] await a booking
d.1) [in the private system] if surgery is required accept/reject their quote
d.1) [in the public system] await a booking
d.2) [in the private system] if the quote is rejected goto ‘a’ or ‘c’.
A recent experience suggests some practitioners in our private system are ‘chasing’ US-level fees. A Canadian reinforced agreement. To wit:
The good and the bad.
- My GP graciously bulk billed and sent me for a CT scan that bulk billed. The public system currently has about 30,000 waiting for treatment and my problem would be the equivalent of standby (maybe someday) priority - estimated wait for a ‘hello’ here was about a year.
- Electing to go private I was referred to a specialist practice that had a 2 months wait for an initial consultation along with some flags they might be expensive, such as a 1% card surcharge. Expecting the GP knows ‘the best locals’ I went with it.
- The first consultation sent me for an MRI. I asked if they could recommend a local bulk biller - they could not but I got a bulk billed MRI in a week.
- It was a month for the subsequent consultation, MRI ‘in hand’. The conclusion was I could chose to live with it or have surgery.
- How much? ‘My assistant to get you a quote.’ At this point I noticed the word ‘customer’ was always used in lieu of ‘patient’ in their documents. A message of what was to come?
- Two days later I receive a quote to accept. The out of pocket looked high and the quote highlighted to assure one’s private health covered the procedure.
- I confirmed cover and had a chat with the fund agent. They mentioned the out of pocket looked very high in their experience. Some quick research on the item number revealed it was 3.5 times the schedule fee for a surgery that the specialist mentioned was neither complex nor dangerous as surgery goes.
- The anaesthesiologist, assistant surgeon(s), and radiologists (if required) would have their individual independent bills. How much would they be? ‘Once you accept the quote and we schedule you in hospital we can determine who they will be and you can ring them to ask their fees.’ Last surgery I was provided with short lists to contact about fees prior to scheduling in and all were forthcoming. On one hand there is some rationale to that but on the other ‘not my problem’ and/or ‘we do not care it is your concern.’
- Bottom line is that surgeon charges in the upper range of a surgeon operating in the US.
The first surgeon is busy and obviously highly skilled, but until one meets with the dollars asked it is less obvious they are pricing their skills at an ambit level in the Australian environment. Discovering this is difficult and opaque so I can understand why they have a backlog of trusting ‘customers’ who just accept what is put to them. Their time as well as mine was essentially wasted because if I had their fee up front I would probably have gone elsewhere in the first instance.
The health fund has lists of providers and their ‘fees’ reasonably grouped into ‘no gap’ and a few ranges of gap as percentages above the schedule, as general guidance for where a provider prices themselves. As it is a small fund they do not have sufficient histories with many surgeons so there is often no data.
- It looks like a gap over 50% is considered high, but a gap of >200% after investing time and some dollars to discover?
- Back to ‘c’ with a booking for a very qualified surgeon where most of his work falls into the lower end of the ‘fee guidance’. As an aside surgeons who only do private practice seem to be costly compared to those who also work in our public hospitals and take private patients in private hospitals on the side.
I am feeling quietly confident it will go better in January.
