Four Corners lifts the lid on gap costs

Back to all news 29 May 2018

A recent Four Corners program on the ABC called “Mind the Gap” has highlighted that some patients are paying thousands of dollars in out-of-pockets costs for surgery and other services because of doctors charging excessively. The program acknowledged most doctors are doing the right thing but there are those few who are charging patients well above what would be considered a reasonable rate. And this contributes to the rising cost of healthcare. 

View the Four Corners program

Some of the issues highlighted in the program included:

  • There is no regulation over what doctors can charge and insurers are limited on what they can pay.
  • Bill creep - where a patient needs multiple procedures, tests and consultations and fees are charged above the scheduled fee on each procedure. 
  • Hidden fees, such as booking or administration fees, that surgeons charge patients on top of their quoted medical costs.

The program quoted Royal Australasian College of Surgeons (RACS) president John Batten who advised that booking fees or other fees beyond the surgical fee should not exist, are unethical and may be illegal. 

"If a patient sees a fee like that appearing on a statement, they need to ask their doctor what it was for and what the clinical or medical relevance of that is, and if they don't get a satisfactory answer, they should not pay that fee. Health funds can't cover the fee as it is not for a medical procedure," TUH chief executive officer Rob Seljak said.

Mr Batten also stated patients often think that because they are paying more it means they are getting higher quality service but there is no evidence to suggest there is any correlation between higher priced surgery and quality. He advised the RACS would like to hear from patients who believe they may be getting charged excessively. Contact can be made via the RACS website.

TUH wants to keep healthcare affordable for all our members so if you’re concerned about high-cost treatments, you can do the following to lessen your gap:

  • Ask your GP to help you find a specialist who may participate in an access gap agreement (where you will have reduced or no out-of-pocket costs) or known gap agreement (where the out-of-pocket costs are capped).
  • Check with TUH. Our website lists specialists who have participated in our Access Gap scheme, or who charge either no gap or a known gap. 
  • Before you consult a specialist, ask for a quote up-front which contains all likely out-of-pocket costs, including the anaesthetist (if applicable), surgical assistant and diagnostic tests. This is known as "informed financial consent" and is your right as a patient.
  • After treatment, if you have had complications or there are unexplained charges on the bill, don’t pay it unless you have an explanation from your doctor. 
  • Consider travelling outside of your immediate area to access health care options that maybe more affordable.

Find out more about Access Gap and participating specialists here.

Choosing the right fund is important too. TUH continues to work towards minimising out-of-pocket costs for our members. In the Commonwealth Ombudsman’s State of the Health Funds report for 2017, we were ahead of major competitors in the percentage of no gap or known gap services.

Source: State of the health funds report 2017