Overcharging doctors exposed under Medical Cost Finder revamp

A new government website will expose Australian doctors who are overcharging their patients and reveal the stingiest health funds.

EXCLUSIVE: A new government website will expose Australia’s overcharging doctors and reveal the stingiest health funds.

Health Minister Greg Hunt is revamping the government’s Medical Cost Finder website so that it names individual doctors and the fees they charge, so patients can find the best value service.

It will also disclose the amount each health fund pays in rebates for different surgeries showing which provide the best value for their members.

The development comes as we can reveal price-gouging doctors are not the only reason patients are being slugged with out-of-pocket fees — Medicare and health fund benefits have not kept pace with inflation.

Health Minister Greg Hunt. Picture: NCA NewsWire / Martin Ollman

It also follows our investigation on Sunday showing it can be cheaper for patients to fly interstate for surgery.

“A small minority of medical specialists have been, in recent years, charging very high out-of-pocket medical fees which, in some cases, cause material financial harm to patients,” Mr Hunt said.

The government’s website was set up “to allow people to compare and to call out the behaviour of anybody who is overcharging or out of line with the general practice”.

“My goal is always to make medical expenses, more affordable, and the first driver of that is bulk billing. Bulk billing means zero costs for people and as you know it’s up from I think 82 per cent when we came in to 88.7 per cent for GP’s and it’s up 4.4 per cent for Medicare right across the full spectrum,” he said.

However new analysis shows in the ten years between 2009 and 2019 health fund premiums rose 58 per cent, inflation went up 22.1 per cent but Medicare rebates rose by only 5.8 per cent.

The assessment, by the Australian Medical Association (AMA), found the federal government froze Medicare rebates at 2013 levels for six years until 2019 and health fund rebates which are pegged to Medicare rebates also did not rise.

“There has been decades of sub-inflation indexation of payouts to patients,” AMA president Dr Omar Khorshid said.

Australian doctors who overcharge their patients are about to be put on blast. Picture: istock

Another reason for gap fees is health funds all pay doctors different amounts for the same procedure — sometimes the difference is as high as 20 per cent.

Bupa pays a rebate of $2510 for a hip or knee replacement in Victoria compared to HCF’s $2145, nib’s $2087 and Medibank’s $2063.

Bupa also pays doctors different rates in different states.

For example for hip and knee replacements Bupa’s rebates are $2510 in Victoria, $2470 in South Australia and $2162.30 in NSW and Queensland.

This is why it is cheaper for their NSW and Queensland members to fly interstate for surgery.

Carol Benning was stung by massive out of pocket expenses of $7600 for recent surgery to remove a cancerous tumour from her kidney.

Almost half the amount was for parts associated with the robot used in her surgery which Mildura Health Fund refused to fund even though she had paid for top health cover for 40 years.

She was only told just before the surgery the parts would attract a fee.

“I was a bit upset yes. You assume that we would get quite a bit more,” the 70 year old retired teacher’s aid said.

Mildura Health Fund CEO Gerard Op de Coul said medical evidence showed there was no overall improved outcome from using a robot to carry out the surgery and there were cheaper alternatives available.

Dr Khorshid explained another reason for huge out of pocket fees was the way health funds ran their no gap schemes.

“Rebates plummet when a doctor’s fee goes $1 outside insurer ‘gap’ schemes,” he said.

For example health funds will pay doctors a rebate of $1143 for a hip replacement if they charge less than the gap scheme amount set at $2662.30.

If the doctors charge $2663 for the surgery the rebate plunges to $339 leaving the patient $1316 out of pocket.