Cancer patients who use health insurance face out of pocket fees of $10,000

AUSTRALIANs are spending thousands on private health cover but can’t afford to use it because of soaring fees. So what’s the solution?

ONE-in-four cancer patients had out of pocket expenses of more than $10,000 because health funds and Medicare rebates no longer cover the full cost of treatment a survey has found.

The startling fees have been uncovered by a major survey of health consumers that found patients complaining they can’t afford to use their private health insurance.

Despite being forced by government policies to spend thousands on health insurance premiums the risk of out of pocket fees means they have to rely on the public hospital system when they need care.

The Consumer’s Health Forum which conducted the survey of 1200 people, says high fees charged by surgeons and inadequate cover by insurers is undermining the private health system.

Consumers can’t use their health cover because of soaring gap fees. Picture Getty Images.

News Corp last month revealed many specialists are contributing to gap fees by charging patients 10 times the fee recommended by the Australian Medical Association. You can check if your doctor is overcharging using this tool.

We also found huge differences in the rebates paid by the big four health funds for the 20 most common hospital procedures.

Health fund data shows 8 in 10 hip and knee replacement patients, hysterectomy and gall bladder removal patients face gap payments as do seven in 10 undergoing prostatectomy, appendectomy and breast lumpectomy.

“A concerning finding to emerge from the survey was that there is a perception among consumers that using PHI is more expensive than not using it,” the report says.

NSW patient Careena told the survey “I had private health cover however it would have cost more if I was to use it. I also found being category 1 there was no delay for any treatment.”

The ongoing freeze on Medicare rebates means patients are also being crippled by massive out of pocket medical bills for specialist appointments.

Many specialists charge over $300 for a consultation but the Medicare rebate is just $72 and has been frozen since 2014.

Medicare rebates for scans have been frozen for 20 years. Picture supplied.

Medicare rebates for scans have not been raised for over 20 years and gap fees for X-rays and other scans were one of the most common complaints in the survey particularly MRIs, for breast cancer for which there is no Medicare benefit.

A third of respondents said the out of pocket costs were not explained to them before treatment.

Private Healthcare Australia chief Rachel David said she did not want to diminish the distress of those paying gap fees but because of the way the survey was conducted it may have attracted only those who had a complaint to make.

She plans to fund a large random survey of all health fund members to better understand the gap problem.

CHF says soaring out of pocket medical bills mean one in five Australians can’t afford to see a doctor, one in six can’t afford to buy their medication and almost half those aged over 45 can’t afford to see a medical specialist.

Risks of a two tier health system. Picture istock.

The report warns we are at risk of creating a “two tier system where your income determines your health care”.

The Chief Medical Officer is conducting an inquiry into out of pocket medical expenses and the survey was conducted to gather evidence of the size of the problems facing patients.

To solve the problem the Consumers Health Forum wants the government to fund an independent website which publishes health practitioner fees and doctors performance indicators.

The 20 year freeze on Medicare rebates for scans should be lifted and patients should be given single quote for any episode of treatment that includes all health professionals’ costs, the forum says.

The government should fund a health system navigator to assist people to understand the private health system and to promote awareness about how to avoid gap fees.

And a Productivity Commission inquiry should be held into cause of the out of pocket fee crisis and all aspects of private health, the forums says.

Originally published as Cancer patients who use health insurance face out of pocket fees of $10,000