Is your specialist overcharging? Now you can compare out-of-pocket costs

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Source: Getty.

If you find yourself needing to see a medical specialist, the experience can be made even more daunting by the unpredictable and often hefty out-of-pocket costs many patients are left facing.

Factor in the matter that the services of individual specialists can vary in price, sometimes drastically, for the same treatment or procedure, and the issue becomes even harder to get your head around – not to mention figuring out how much you’re actually covered for under your private health policy.

This is an issue that the medical and insurance industries are acutely aware of and now one health fund has come up with a way to make the task easier for consumers when it comes to pre-empting those large bills, launching a digital platform where specialists’ costs can be easily compared.

Not-for-profit health fund HCF have compiled an easy-to-use tool that allows fund members to access valuable information about the out-of-pocket expenses they will be charged by individual specialists, in a bid to help them avoid gap payments.

“Fees can vary widely between medical specialists and it is difficult for consumers to make informed decisions when selecting healthcare providers,” said Dr Andrew Cottrill, HCF’s Medical Director. “We are advocating for increased transparency around costs for our members.

“By developing this platform, we want to empower our members to make decisions with a greater awareness of the potential out of pocket costs they may face.”

Developed in collaboration with HealthShare, and available via their website, HCF members can use the new tool, which is the first of its kind in Australia, to improve fee transparency and avoid surprises when it comes to costly health decisions. While GPs can also access the data via their clinical software, helping them to inform discussions with their patients about the potential cost of their treatment.

Using the platform, members simply select a particular specialist and access a drop-down menu to select one of the common procedures performed by them, before being shown a list of the out-of-pocket expenses that other HCF members have been faced with for that procedure.

Private Healthcare Australia CEO Dr Rachel David told Starts at 60 that the out-of-pocket costs charged by private specialist doctors and dentists are a “major concern” for consumer health funds, adding that around 40 per cent of all private patients admitted to hospital will be faced with a gap payment.

“A private patient may experience unexpected costs from both hospitals and medical specialists,” she said. “However, under Australian law, private specialist doctors are not treated as employees and are able to charge what they like.

“Many of them choose to enter into ‘no-gap’ or ‘known gap’ arrangements with health funds, which help to minimise out-of-pocket costs for patients.”

David added that the responsibility falls on the individual specialists to make their patients aware of the costs associated with a specific procedure, however a recent survey of health fund members found that 30 per cent of those who had been admitted to hospital in the last five years were surprised by the out-of-pocket costs they had to pay.

She added: “Greater transparency on cost is needed to enable consumers to identify and select suitable providers at the time of referral, and to support GPs in informing their patients. For example, information on average OOP costs and charges per procedure, including a range of possible expenses, would give consumers a sense of potential charges they could face when undergoing a procedure.”

Have you been left with huge out-of-pocket costs? Do you have private health cover?

Members can see what others have paid for the same procedure. Source: Getty.

Important information: The information provided on this website is of a general nature and for information purposes only. It does not take into account your objectives, financial situation or needs. It is not financial product advice and must not be relied upon as such. Before making any financial decision you should determine whether the information is appropriate in terms of your particular circumstances and seek advice from an independent licensed financial services professional.

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