Bupa CEO compares doctors charging medical gap fees to greedy bankers

Desperately ill patients are being forced to remortgage their homes, raid their superannuation and seek crowd funding to cover exorbitant medical bills not covered by Medicare or health funds.

Exclusive: The boss of Australia’s biggest health fund has compared medical specialists charging super-sized fees to bad bankers and says they should be hounded out of the profession.

The call comes as frustration is building in the private health insurance industry over delays in government action on a major investigation into medical gap fees carried out by the Chief Medical Officer Brendan Murphy.

Health funds have evidence of massive out of pocket fees of over $20,000 for deep brain stimulation for Parkinson’s disease and $10,000 for hip and knee replacements that are not covered by Medicare or health funds.

MORE: Is your doctor overcharging you?

MORE: Secret fees charged by doctors

Patients are copping massive out of pocket expenses not covered by Medicare or health funds.

Cancer patients are being preyed on by doctors charging gaps of $12,000 for breast reconstructions or over $10,000 for robotic prostatectomies.

Bupa managing director Dwayne Crombie says medical specialists imposing such fees risk losing community respect in the same way as disgraced bankers did through the Royal Commission.

If they want to maintain their standing their medical colleges must move to define what they consider unacceptable fees and ban doctors who charge above this amount, he told News Corp Australia.

“They should fix the people who charge outrageously and kick them out,” he said.

“Potentially they could revoke their right to get Medicare and private health insurance benefits,” he told News Corp Australia.

Dwayne Crombie, head of health insurance for Bupa Australia, says greedy doctors risk losing respect in the same way as disgraced bankers. Picture: Hollie Adams/The Australian

The president of the Royal Australian College of Surgeons Dr John Batten has also attacked the charging practices of some of his colleagues as “immoral” and “unethical” and warns it could see patients abandon the private health system altogether.

Already there is evidence that privately insured pregnant women are refusing to pay exorbitant pregnancy management fees of $13,000 and are using the public system instead.

The proportion of women using public hospitals to give birth is rising.

Dr Batten says his college is an educational body and can’t dictate what doctors can charge and he says the actions of successive governments in freezing Medicare rebates and health funds following suit are also behind growing medical gap fees.

The Royal Australian College of Surgeons has set up a complaints process for people upset about large out of pocket medical expenses which has received a handful of complaints and said some doctors have been disciplined.

Greedy doctors could prompt patients to abandon the private health system altogether.

In the 12 months between December 2017 and December 2018 the college received 46 inquiries of which only a small portion escalated to complaints on fees.

As a result of investigations one surgeon received a Level 2 sanction in which they were censured and found to be in breach of the college’s Code of Conduct.

The sanction may restrict the Fellow’s participation in college committees and teaching and they will be required to undertake training courses, and may have their practice reviewed.

A survey of 6000 health fund members conducted for the government has found 44 per cent of health fund members face gap payments not covered by Medicare or their health fund.

Private Healthcare Australia chief Dr Rachel David says health fund data shows two per cent of patients are being charged an “egregious fee” — much more than the fee recommended by the Australian Medical Association for the service.

Chief Medical Officer Brendan Murphy. Picture: Kylie Else

A recent survey found eight per cent of patients were also being charged secret upfront booking or administration fees that can’t be declared to Medicare or health funds.

Funds want these outlawed.

A New Corp Australia investigation into overcharging last year found some doctors were charging 10 times the AMA fee for some procedures.

These gap payments total more than $1.6 billion a year and Australians are being forced to seek crowd funding or remortgage their homes to pay the bills.

More than 15,000 people a year are raiding $290 million from their superannuation to pay for medical care not covered by health funds or Medicare.

The Chief Medical Officer’s report on the problem was handed to Health Minister Greg Hunt last year.

It is believed to call for a government website that would list doctors fees to help patients locate the best value doctors.

However, Health Minister Greg Hunt has yet to act on the matter.

The out of pocket expenses are devaluing private health insurance and driving people to drop their cover.

Health fund membership slumped by a further 12,370 people in the three months to December 2018 to just 44.6 per cent of the population.