How much will you have to pay your medical specialist? | ABC News | Summary and Q&A

TL;DR

Private health insurance can result in significant out-of-pocket costs, which vary depending on the insurance plan and the specialist's fees.

Key Insights

• 🧑‍⚕️ Out-of-pocket costs in private health insurance can be complex and vary based on individual factors.
• 🤱 Medicare covers a portion of the specialist fees, leaving the remaining amount as the patient's responsibility.
• 🤱 Many specialists have arrangements with insurers, but others may disregard suggested fees and charge premium prices.
• 🇨🇷 Hidden costs, such as booking fees, can further increase the overall out-of-pocket costs for patients.

Transcript

this is Frank he has arthritis in his hip his GP referred him to an orthopedic surgeon who's recommended he undergo a full hip replacement Frank doesn't want to join the end of a long waiting list at a public hospital so he's decided to make use of the health insurance he shells out for each month and go through the private system he knows there wi... Read More

Questions & Answers

Q: How does a private health insurance plan affect out-of-pocket costs for medical procedures?

Private health insurance plans play a significant role in determining out-of-pocket costs, as they vary in coverage and benefits. The costs can be influenced by factors such as specialist fees and whether the insurer has agreements in place to cover the gap fees.

Q: What are gap fees, and how do they impact out-of-pocket costs?

Gap fees are the difference between the specialist's fees and the amount covered by Medicare and the private health insurer. If a specialist has a no gap arrangement, the insurer covers the entire gap fee. However, if there is a known gap arrangement, the patient is responsible for paying the difference.

Q: Why are some medical specialists not constrained by regulations when setting their fees?

In Australia, medical specialists have flexibility in setting their fees as they are not bound by regulations. While the Medicare benefit schedule provides a benchmark, many specialists argue that the listed fees are too low and do not reflect the true cost of services.

Q: What are some additional costs that may arise during private medical procedures?

Apart from specialist fees and gap fees, there can be other hidden costs, such as booking fees. These fees, which may not be known to the insurer, can add to the overall out-of-pocket costs for patients.

Q: How does a private health insurance plan affect out-of-pocket costs for medical procedures?

Private health insurance plans play a significant role in determining out-of-pocket costs, as they vary in coverage and benefits. The costs can be influenced by factors such as specialist fees and whether the insurer has agreements in place to cover the gap fees.

More Insights

• Out-of-pocket costs in private health insurance can be complex and vary based on individual factors.

• Medicare covers a portion of the specialist fees, leaving the remaining amount as the patient's responsibility.

• Many specialists have arrangements with insurers, but others may disregard suggested fees and charge premium prices.

• Hidden costs, such as booking fees, can further increase the overall out-of-pocket costs for patients.

• Some specialists are considered "rockstars" and charge significantly higher fees, leading patients to resort to crowdfunding for financial support.

Summary & Key Takeaways

• Frank is referred to an orthopedic surgeon for a hip replacement and decides to use his private health insurance to avoid long waiting lists at public hospitals.

• The out-of-pocket costs for Frank depend on his insurance plan and the specialist's fees, which can vary significantly.

• Medicare covers 75% of the Medicare benefit schedule fee, leaving the remaining amount as a gap fee that Frank has to pay.