talking to doctor

Talking to your doctor about costs

Some people feel awkward when talking about the cost of their medical treatment. While they’d normally shop around for the best price for a new car, fridge or telly, they suddenly get shy when talking to their doctor.

Why is that?

Maybe it’s the status we attribute to medical professionals. Or possibly the feeling they’re locked in to a treatment plan and have no negotiating power anyway. Perhaps they think it’s rude or inappropriate to combine dollars and medical treatment in the one conversation.

Whatever the reason, it’s something we need to get over. Because if ever there was a need for greater transparency for consumers around the cost of their medical treatment, it’s now.

By law, a doctor must explain all the costs involved in your treatment – including the fees that will be charged by other professionals (such as anaesthetists or assisting surgeons). You must be told how much the treatment will cost in order to give your informed financial consent.

Every medical procedure has an item number and a fee determined by the government under the Medicare Benefits Schedule (MBS). There could be several item numbers involved in your hospital treatment and Medicare will chip in 75% of the MBS fee for each. Private hospital insurance will cover the remaining 25% of the MBS fee when you’re an admitted patient (in-patient).

But doctors are free to set their own fees – and many do set them higher than the MBS fee. Unfortunately, some doctors set their fees much higher – leaving their patient with a rather large out-of-pocket bill for an operation!

Even the President of the Australian Medical Association, Dr Michael Gannon, says gaps of “$5,000, $10,000 or $15,000 are difficult to defend.”

Speaking at the National Press Club in 2016, Dr Gannon said, “excessive fees are not appropriate,” and that he’s “never seen anyone who’s worth five figures for two hours work.”

If your doctor proposes an excessive fee, you should ask the doctor to use a gap-cover billing arrangement to eliminate or reduce the out-of-pocket medical cost. Legislation allows private insurers to pay slightly more towards doctors’ fees when they agree to cap the expense to the patient.

Defence Health has Access Gap which contributes to 90.6% of our members having no-gap at all for their in-hospital medical charge.

If your doctor won’t agree to using gap-cover like Access Gap, you have a right to find one that will. Excessive doctors’ fees undermine confidence in the health system. They’re also unfair for people who are already making sacrifices to maintain private health insurance.

That’s why it’s so important to have the ‘cost conversation’ with your doctor. It could be the difference between having no-gap (or a small known-gap) for your treatment or a devastating, or surprising, out-of-pocket expense that your insurer can’t cover.

Learn more about out-of-pocket expenses:

Category: Your Insurance


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Article by: Defence Health