HCF reveals out-of-pocket fees

Health insurer HCF is arming its members with details on the out-of-pocket fees charged by a range of specialists.

Health insurer HCF is arming its members with details on the out-of-pocket fees charged by a range of specialists as the industry awaits the release of a government report on the issue.

The not-for-profit fund has developed a new tool in partnership with digital health platform HealthShare to help its members avoid or minimise gap payments.

Grattan Institute health program director Stephen Duckett said the number of complaints about unexpected out-of-pocket costs was increasing.

“That issue is one of the cases of dissatisfaction with health insurance, so it is in health insurers’ interest to provide this information to consumers,” he said.

The increase in out-of-pocket costs has the attention of the federal government, and Health Minister Greg Hunt ordered Chief Medical Officer Brendan Murphy to review the issue more than a year ago. The government now has the final report and the industry is awaiting its release.

Mr Duckett said it was obvious there was a need for more information about the gap payments and he hoped the government would take responsibility for that, as well as insurers.

“The government has a role and should be doing some of this itself, as it has all the data, but it is important for insurers to also do this as they have a vested interest,” he said.

Andrew Cottrill, HCF’s medical director, said fees could vary widely between medical specialists and it was difficult for consumers to make informed decisions when selecting healthcare providers.

“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,” Dr Cottrill said.

HCF has already provided information on how frequently specialists — who participate in its known or no gap scheme — charge less than $500 in out-of-pocket expenses. This latest tool adds to this by showing what a specialist’s out-of-pocket costs might be, based on HCF’s claims data.

The data would also be available to general practitioners via their clinical software, to inform patients about the likely cost of treatment.

“This is about HCF trying to unlock the power of our data for the benefit of our members and being more transparent with data so members can make more informed healthcare choices,” Dr Cottrill said.

“We know from our own research that 36 per cent of HCF members who attend hospital receive higher than expected gaps.”

Dr Cottrill said the medical fraternity realised it had to be more transparent but insurers also had to be open about the rebate they provided doctors, which HCF’s out-of-pocket tool would cover.

“We try to (encourage) specialists to minimise or eliminate the gap payment … not everybody will want to participate in that, so the challenge for us is setting robust rebates that will capture as much as possible,” he said.