Revealed: Health procedures with highest costs

Retired nurse Anne Leonard was hit with a huge out-of-pocket bill for her recent surgery, as hundreds of thousands of patients are being forced to raid their superannuation to pay outrageous medical gap fees.

Exclusive

Some patients are being slugged with out-of-pocket bills of more than $10,000 for surgeries that are not covered by Medicare or their health insurer, new health fund data reveals as surgery prices surge post Covid

It comes as News Corp can reveal just 10 specialists have listed their fees on the government’s medical fee transparency website – Medical Costs Finder - which is meant to help patients find better value doctors and cut their medical bills.

As hundreds of thousands of patients are forced to raid their superannuation to pay surgery gap fees we can reveal a list of the highest out-of-pocket bills compiled by private health funds.

It shows some brain and spine surgery patients were charged more $10,000, some prostate surgery patients more $8,600, weight loss surgery patients slugged $7,500, and shoulder replacement patients copping out-of-pocket bills of more than $6,000.

Around half of all privately insured patients are now paying gap fees when they have surgery and these gap fees have surged by 300 per cent since Covid.

Dr Rachel David, chief executive of Private Healthcare Australia. Picture: Kym Smith

The out-of-pocket costs undermine the value of private health insurance and means patients are paying three times for healthcare.

First they pay the Medicare levy, then they pay health fund premiums and then they face massive gap fees when they use their health cover.

Health care lobby Private Healthcare Australia said if doctors are refusing to voluntarily make their fees public, it’s time for the Federal Government to publish the Medicare data that shows what surgeons charge on the Medical Costs Finder website.

“We think the department should publish all the data they have on fees on the Medical Costs Finder website,” Private Healthcare Australia CEO Dr Rachel David said.

“The department has gone out to surgeons and tried to encourage them to publish their own fees on the site and basically none of them have,” Dr David said.

“That part of it is not working.

“Many consumers assume that paying more for treatment guarantees a better outcome. This is rarely the case. In Australia,where medical training is rigorous, most doctors with equivalent qualifications perform at the same level, and paying moredoes not mean you’re getting ‘the best’.”

Taxpayers have spent more than $24 million on the Medical Costs Finder website which was launched by the former governmen tfour years ago to eliminate medical “bill shock”.

An exploration of the website this week showed a search for colonoscopy specialists returned fee rates just two doctors in the whole of Australia – one in Tamworth in regional NSW and one in Malvern, Victoria.

Just two surgeons have prices listed for hip replacements and the same two surgeons are the only ones who list their fees for knee replacements.

The Department of Health revealed 455,000 patients desperate for fee help have used the site since 2019 but just 10 doctors list their fees.

Professor Alan Fels called for a crackdown on medical price gouging. Picture: David Geraghty

A further 62 doctors have registered on the site but have not yet listed their fees.

“The former Government did nothing to make the Medical Cost Finder a useful tool for consumers,” Health Minster Mark Butler said.

“I’ve asked my Department for advice on how we can improve the current Medical Costs Finder and transparency.”

Former competition watchdog Professor Alan Fels’ recent Price Gouging and Unfair Pricing Practices report called for a crackdown on egregious billing by medical specialists.

“A lack of informed choice means there is little competition between providers and excessive market power such that patients are worse off,” his report said.

Out-of-pocket fees charged by specialists, such as surgeons and cardiologists, increased by more than 50 per cent in real terms from 2012 – 2022, the report found.

Australian Medical Association president Dr Steve Robson. Picture: NCA NewsWire/Martin Ollman

Australian Patients Association CEO Stephen Mason said in addition to out-of-pocket fees for their specialist “a lot of patients when they get a bill, often many months after the treatment for a second assistant surgeon they didn’t know was there”.

“They didn’t consent to the second surgeon,” Mr Mason said.

He backed calls for improvements to the Medical Cost Finder website.

“It was a very modest start well intended, but it hasn’t really helped many people,” he said.

Australian Medical Association president Dr Steve Robson said many factors were behind rising gap fees.

“Medicare rebates have fallen well behind inflation for years and, for those services in a private hospital, the fees paid by insurers are not keeping up with practice costs,” Dr Robson said.

I’M NOT GETTING THAT MONEY

After paying more than $1000 in out-of-pocket fees for her recent ankle surgery in a private hospital, 74-year-old retired nurse Anne Leonard was shocked to be given another bill for $800 for follow up appointments with her surgeon.

Ms Leonard said she was told she could not claim a Medicare rebate for the fee and it would not count towards her reaching the government’s Medicare Safety Net, which dramatically slashes the bills of patients once they spend a large amount on out of pocket fees.

“I just was flabbergasted when I really sat down and thought about this,” Ms Leonard said.

“Why should a surgeon, any surgeon do this?”.

Retired nurse Anne Leonard paid $1000 in out of pocket fees for her ankle surgery, then her specialist charged her $800 for post operative care which she could not claim on Medicare. Picture: Supplied

Rushed into hospital three days after first seeing the surgeon, Ms Leonard said the $800 charge was disclosed in the financial consent documents she signed but said she did not properly understand the implications at the time.

She was charged the $800 fee at her first post-operative appointment and said she did not receive a receipt from the doctor that she could take to Medicare.

“I can’t claim anything on the Medicare Safety Net because I haven’t got a receipt with an item number on,” she said.

The doctor then bulk billed Medicare for several subsequent visits she made after a series of complications following her surgery.

Usually a surgeon would charge around $130 for each post-surgery appointment and the patient could claim a Medicare rebate that would count towards the Medicare Safety Net.

If she had been billed in this way it would have taken 10 appointments before the doctor recouped $800 in gap fees, she said.

“I thought every person as Australia was entitled to a rebate when they saw a doctor. I’m not getting that money,” she said.

“I’m speaking out because I want to prevent another person from having to pay this,” she said.

Originally published as Revealed: Health procedures with highest costs