CHOICE membership

Surprise medical bills.... after the fact


#1

following on from this thread

My wife and I were fortunate to have a healthy baby, through the private system. I was expecting a few extra bills, but they’re pretty excessive. i.e. $455 for two 10minute consultations with a paediatrician, both were non-urgent and during business hours (Medicare covers $170 of this). Which we were told were compulsory.

Does anyone have any experience or success in having medical specialist fees reduced after the service has been provided? If so, how did you go about it?

As a starting point, I would quote the informed financial consent guidelines from the Royal Australian College of Surgeons. But I can’t find anything similar for Physicians.


#2

@southerton this is really interesting - please let us know how you go! I’ve heard of people negotiating before, obviously, but if you’re negotiating the price after, it might be worth taking a look at the item number and the service you got, and seeing if they match up. If you don’t think you got the service you were charged for then I would suggest approaching them on that basis. It’s a tricky one though, the medical professional certainly doesn’t like being questioned on costs.

We’re going to take a bit of a look at this idea of “informed financial consent” as I think there’s a lot of room for improvement there. I might even approach the physicians and see if they have an answer for us on this.

One good example of informed financial consent was a friend who had to get a cardiogram, when he made the appointment over the phone they were very upfront about the price ($500ish) and said they told their patients beforehand because sometimes the cost would stress people out and change the results of their test! However, all this meant that he was aware of the cost, and, if he wanted to he could have called another clinic to compare price.

Look forward to hearing how you go - and maybe someone else has advice for you here.


#3

I’d love to know if they have any guidelines for providers.

Would the ACL have something to say about this?

This page is relevant from the ACCC

Doctors are obliged by common law and professional practice obligations to provide sufficient information to ensure informed consent by patients. This includes

  • charges, including for ancillary and add-on services.

AND
http://www.medicalboard.gov.au/Codes-Guidelines-Policies/Code-of-conduct.aspx

3.5.3 Ensuring that your patients are informed about your fees and charges.

We certainly weren’t made aware of any of the costs, and it was also on us to ask. It’s just you don’t have a choice when you’re already in there and they won’t let you take your baby home until seen by a paediatrician.


#4

Many, many years ago I received a surprise medical bill after my wife and I went to see a Canberra fertility specialist I won’t name given his fraudulent actions.

This doctor was clearly very well-off, had his current-model BMW and wonderfully appointed offices. On the way out of our one visit to him (his advice was so useless we never went back - and I was furious at his billing), we learned how he could afford all of this.

His receptionist issued an invoice based upon his instructions, charging each of us for a consultation! We saw him together, and this fraud billed for two consultations!!!

I made quite a bit of noise, but my wife persuaded me to just ‘move on’ - and not to report his misdeed to Medicare (yes, he was billing Medicare i.e. the taxpayer twice). I appreciate most of her advice, but still regret that I listened to her that time.

“I saw both of you, and spoke with both of you. That constitutes two consultations.” GRR!


#5

@southerton, in addition to how surgeons/specialists approach ‘informed consent’ have you ever tried to find out if a surgeon or GP has complaints or malpractice suits against them, or what their record of ‘adverse outcomes’ is? They protect themselves and are protected behind an opaque wall.

The so-called regulatory agencies receive complaints from citizens but they then go into a dark hole. Peer monitoring? I found this slightly dated text (it appears to be from the Davies Commission in Queensland, but other than heading this copy is unattributed as to exactly where it fit, if anywhere).

Separately a senate enquiry was held on out of pocket health costs and a submission (#29 with redactions to protect those being referenced) can be seen here. While this has comparisons between public and private from a focused lens, comparing content to that of the Davies Commission can be educational in a few ways.

And lastly, although with political overtones, there is some good commentary for thought here.

Medicine is a very special industry.


#6

I worked with a nursing colleague who needed a Hysterectomy operation. She was told it would cost a lot more $'s than her friend had been charged by the very same surgeon at the same hospital, so she asked him why.
Immediatley the cost was reduced.
Always ask, Q and get another opinion too. They’re akin too car mechanic’s in that way.


#7

I’ve asked to be bulk billed at a Ear Nose & Throat Doc, and he did.
Another Doc told me to ring the specialists I was going to prior to making an apt & ask he’d bulk bill.


#8

My partner recently attended a Private Hospital Emergency Dept and was subsequently admitted with emergency surgery the same night. For the next three days, the specialists monitored progress through the use of standard blood tests. We are in top cover, so no excess for the hospital private bed; no excess for the specialist nor for his anesthetist. However the blood tests - which the specialist assured us were standard tests performed by machine - were three times the value of the Scheduled Fee. The same tests performed at a clinic are generally “free” (ie scheduled fee). Plus a fee for the privilege of the phlebotomist coming to your bed which was $43 per time. (Mulitply that $43 by say 30 beds per ward ) The exhorbitant charges for a couple of vials of blood were ridiculous. When people attend a private hospital, they are warned to check the excesses for the bed, the surgeon, and the anesthetist but no mention is ever made of the possible excesses for pathology or radiology. We are captive to the exclusive agreements made between the hospitals and their providers. Some investigation may be needed into these deals over which the patient has no influence or control.


#9

Thanks for letting us know @Yannie, I’ll be sure to pass on your experience to my colleagues working in health insurance.


#10

My mother also experienced someone similar. At the Wesley Hospital, if one has scans through say a GP referral, these scans are either free or very cheap. If one is booked into the hospital, the scan costs escalate considerably. My mother was told to minimise costs on her last visit to get the scans required for hospital assessment/treatment, prior to admitting herself to the hospital. She followed this advice and did the scans and thereafter, admitted herself to the hospital. Doing this she saved a considerable amount of money.

I have also heard that medications when admitted can be free and covered by private health insurance, but those dispensed for going home can be significantly more expensive that competitive pharmacies removed from the hospitals.

Other examples of paying a premium for being a hospital patient.


#11

I have had several surgical procedures over the last few years.

In each case I was upfront with the surgeon, saying that I had very little money for extra bills. In each case, the surgeon agreed to waive any additional fees.

The same was not true of the anaesthetist for each operation, who invoiced me for additional fees, but less than quoted.

I was happy that I wasn’t bankrupted by medical bills, but there was a downside – in each case, I was placed last on the surgeon’s list for the day. Want to be operated on by a tired surgeon? I’m guessing that was my reward for being cheap.


#12

I suspect that there is significant variation in every instance. It may vary between different hospital systems and between states. Relating the comments so far to the histories of both my parents in private systems in the previous ten years, there were no additional costs for any treatment including xrays, pathology, physio etc delivered while in hospital. They paid a daily co-payment of $50 caped after a number of days, five from memory.
Or has something changed dramatically in the previous few years with the way private hospitals function? it is certainly not our own direct and personal experience either, having been in for procedures more recently.

It appears we need more clarity on this topic - assuming also that it needs to possibly consider each state separately?


#13

That it does, as it also does when a specialist declines (or just overlooks) to tick the bulk bill box for a test while the GP always will. It is essentially a dogs breakfast with no menu.


#14

Agree that it could be as simple as a box not ticked for the cost of the tests - but the $43 per visit for the phlebotomist is way over the top. For a ward of 30 beds, that means the company is charging $1290 for someone to go to the ward to take the bloods. whether that is per hour, or per day it is still extortionate. Any length of time in hospital and the pathology company costs more out of pocket than the surgeons. __


#15

The conduct of banks revealed by the Royal Commission pales into insignificance compared with those who exploit the sick.


#16

I worked, in the revenue area in private health when Informed Financial Consent came in.
We went to a presentation by one of the health funds.
They had an excellent, for patients, form that started at the specialist.
It was multi page, and each level of care had a page to add their costs.
So specialist fills in expected Medicare item number, their total cost, as well as Medicare & the patient’s health fund rebate (so out of pocket shown for that part)
Next page was for the hospital showing any costs & out of pocket, so if pt had limited cover, if procedure was covered, if they had top cover, just excess or copayment.
There were other pages for possible rehab stays or pathology (I think)

We, as a hospital LOVED, the idea.

Specialists wouldn’t complete it in case what they billed became known to the hospitals.

So it died before it started.

As far as I’m aware only the private hospitals follow the informed financial consent rules still.

Surgeons should have to honour it as well. With allowances for complications, of course. (Eg colonoscopy becomes colonoscopy with removal of polyps, so slightly different item number/charge)