Before you go into hospital for any proposed treatment as a private patient, it's your right to ask your doctor about his or her fees, and to find out about the fees of other doctors who might be involved in your care.
You should also ask your health fund about what you are covered for, and whether you will have any out-of-pocket costs to pay.
The AMA and the Australian Health Service Alliance Ltd have worked together to find the most common procedures people undergo as private patients in hospital. Click on this link to find out the doctors most likely to be involved in each procedure.
What is a gap?
There are hospital gaps and medical gaps. Our focus is on medical gaps, also called out-of-pocket costs. A medical gap is the difference between the doctor's fee and the combined amount paid by Medicare and a private health fund for a medical service.
What's the average gap?
Most specialists offer a gap-free service. According to a consumer survey conducted by IPSOS in 2004, when a gap did occur, the average gap charged by a medical specialist was $449. Of course, that figure is only an average and could change depending on how complicated or uncomplicated your procedure is, what state or territory in Australia you have your procedure done, and what health fund you are with. That's why you need to ask your doctor about what his or her fees are, and whether there will be a gap amount, also called out-of-pocket cost, for you to pay, as well as contacting your health fund to find out what you are covered for.
8 questions to ask your doctor about costs before you go to hospital
1. What are your fees?
Your doctor will talk to you about his or her fees for any proposed treatment, and, if they can, about any out-of-pocket costs that you might have to pay when you go to hospital.
2. Are there any fees for other doctors?
Ask your doctor about fees for other doctors, such as anaesthetist and assistant surgeon. If they can, your doctor will explain the fees of other doctors involved in your care or they will provide you with their contact details so that you can find out about their fees, and about any out-of-pocket costs that you might have to pay.
3. Will I have any out-of-pocket?
If you have to go into hospital for surgery or medical care, there may be an out-of-pocket cost or medical gap that is not covered by Medicare or your private health fund. A medical gap is the difference between the combined amount paid by Medicare and your private health fund for a medical service, and your doctor's fee.
4. Is your fee an estimate only?
Remember, your doctor can only estimate the cost of your in-hospital or day surgery elective procedure in advance.
5. Can I have an estimate of your fees in writing?
Yes. Either your doctor or the doctor's office staff will provide you with an estimate in writing of the likely cost of your proposed treatment, and, if they can, any out-of-pocket costs that you might have to pay.
6. If the cost changes, when will you let me know?
If an emergency or if something unplanned happens during your procedure, there may be additional costs to you that could not be estimated in advance. This information will be provided to you as soon as possible after treatment occurs.
7. What if I need a prosthesis?
Prostheses include pacemakers, defibrillators, cardiac stents, joint replacements, intraocular lenses and other devices that are surgically implanted during a stay in hospital. Before surgery, your doctor will tell you if one is required, why you need it and whether it will cost you anything. Most prostheses available won't cost you anything, but if you have an out-of-pocket cost to pay, your doctor will explain why this prosthesis is the best one for you.
8. Should I contact my health fund?
Yes. Check with your private health fund to find out what you are covered for and whether your treatment will result in any out-of-pocket costs.
Remember: If you are unclear about the total costs of your treatment...
Ask your doctor and your health fund.