Unexpected bills

End unexpected medical bills

Have you been hit with an expensive, unexpected bill for surgery? Even if you have private health insurance, if you get sick chances are you’ll be left out of pocket, facing unpredictable and unexpected costs.

This month, the Health Minister’s committee is meeting to decide how to fix this problem. By signing the petition you’ll be adding pressure to the Minister to make the right decision.

Sign our petition to tell the Health Minister and his committee you’re sick of unpredictable hospital bills. You should know what costs you’re up for – a fairer system is possible.

The stress of finding an unexpected bill

What's the solution?

Ask Minister Hunt to cut the confusion by:

  • Making surgeons’ average prices for common procedures available to patients
  • Helping GPs provide more information about specialists’ costs and waiting times to patients before they see a specialist

We want a better system – one that helps patients avoid nasty bills and keeps the cost of private surgery fair. 

Dear Minister Hunt,

It’s time to cut the confusion and stop specialists saddling patients with unexpected and expensive bills for private medical care.

Private health insurance patients are increasingly being left out of pocket, facing unexpected and unpredictable costs when they’re headed to the operating table.

It’s time for a fairer system – one where we can predict and understand the cost of treatment in the private healthcare system.

That’s why we want to see a number of changes to help ease the confusion and hip pocket pain for patients:

  1. Specialists’ average pricing should be more transparent. Average prices for common procedures should be publicly available to patients, including online and on the phone. Patients should be able to access this information before they see a specialist.
  2. Insurers and General Practitioners should encourage competition in the market by providing better and more timely information to help patients compare surgeons and to reduce their out-of-pocket costs for treatment in the private system. This could be enhanced through an open data approach where costs and waiting times are provided by specialists, hospitals and insurers, directly to GPs.
  3. Insurers should make their no-gap and known-gap thresholds for common procedures more accessible to patients. A consistent approach is needed so patients can easily compare between insurers.
  4. Other measures to curb out-of-pocket costs and encourage competition should be considered by the committee, including improving informed financial consent models, capping procedure costs and more.

We need to end the confusion and make the cost of private surgery more transparent for consumers.

Did you know that even if you have top level cover, you can still be out-of-pocket for thousands of dollars for surgery as a private patient?

The way our private health insurance system works is extremely complex, so it’s no surprise that many consumers find themselves saddled with unexpected out-of-pocket costs when going under the knife.

When we launched our investigation into the cost of surgery, we found private patients could be up for lots of extra fees, including:

  • Consultations with your doctor
  • Procedures you aren’t covered for
  • Excess and co-payments
  • Pathology costs, like blood tests
  • Prostheses, such as an artificial hip
  • Hospital incidentals like TV or medication you take home
  • And most importantly, there’s the gap payment for your surgeon and anaesthetist.

But what is the gap payment? A gap is simply the difference between what Medicare and your health fund will pay towards your treatment. In other words, it’s the amount you’ll be out-of-pocket and sometimes that amount can be thousands of dollars.

We think this cost should be low and predictable, not an expensive surprise. In the meantime, find out how to avoid out-of-pocket costs in our helpful guide.

To check what information you can get from a surgeon’s receptionist before committing to an appointment, two CHOICE staffers called 60 surgeons’ offices around Australia:

  • 20 surgeons’ receptionists were each asked for the out-of-pocket costs for a knee replacement, cataract surgery and tonsils.
  • We said we had private health insurance and were fully covered for the procedure.
  • We were insistent and did ask twice if we didn’t get a straight answer.

We didn’t normally have a problem getting a quote for the consultation, but it was a different story when we asked for the out-of-pocket costs for the surgery:

  • 38 of the 60 receptionists told us if there would be a gap or no extra cost for the surgeon.
  • Eight gave us a vague, ballpark figure.
  • 30 gave a more detailed answer and of those, 17 gave us a clear indication of the cost including eight who said there wouldn’t be a gap and five who said there’d be a $500 known gap.
  • 22 didn’t help us. Of those, a small number even declined to make an appointment before getting a fax from our GP.

Our mystery shop shows that while it’s worthwhile to ask questions before you book your appointment, there’s still a lack of transparency. Shopping around can help, but you often only get a clear answer after waiting weeks or months for an appointment. At that point, you may be in too much pain or discomfort to do anything but accept the costs.

There’s also a large power imbalance between a patient and a surgeon. You aren’t shopping for a washing machine that you can walk away from, you’re looking for someone you can trust to restore your health and quality of life.

Has our research got you worried? Find out how to avoid out-of-pocket costs.

Sometimes it’s worth asking, do you even really need health insurance?

If you’re wondering whether you need to take our private health insurance, take the test at doineedhealthinsurance.com.au.

CHOICE has broken down the basics: what Medicare does and doesn’t cover, what changes tax-wise when you turn 31, and how to avoid wasting money.

We’ve also looked at the value of extras, where there’s no tax incentive for your take our cover. You can find out more about the value of extras cover in this helpful guide.

Feeling sick about the cost of your health insurance? Want to cut your costs before premiums rise (again)?

Check out CHOICE’s health insurance finder to find the best value policy.