19 July 2018

Patients call for mandated cap on surgery out of pocket fees

A patient advocacy group has called on the Federal Government to cap the amount surgeons can charge patients for out of pocket surgery fees as part of a range of new measures to halt escalating medical bills for patients.

Australian Patients Association (APA) executive director strategy, Michael Riley, said the association, which provides assistance and referrals for hundreds of patients across Australia each year, will write to Federal Health Minister Greg Hunt and Ministerial Advisory Committee on Out-of-Pocket Costs Chair Professor Brendan Murphy, after an increase in calls to the association from patients hit with out of pocket bill shock.

“With the issue gaining more media attention, there has been a marked increase in patients contacting the association expressing concern at the hit to their hip pocket from unexpected medical bills following surgery,” Mr Riley said.

One call we received involved a woman with private health insurance who gave birth by planned caesarean but was still out of pocket for close to $10,000 to cover unexplained fees for a paediatrician, anaesthetist and gynaecologist.

“The APA believes a lack of transparency and a laissez-faire approach to the charging of unexplained out of pocket fees, is costing patients and the taxpayer funded health system. As a result of patient feedback, we’ll be writing to Minister Hunt and Professor Murphy, outlining some potential changes we believe will improve the system and help patients,” Mr Riley said.

“Importantly, we believe the proposed changes will help limit on the amount patients are out of pocket, improve transparency and clear the confusion and anger many patients are experiencing when hit with huge out of pocket fees when leaving hospital.”

The proposed changes include:

  • The introduction of a new cap on the amount of money patients can be charged for out of pocket fees for surgery and in hospital stays (other than for emergency surgery).
  • Federal and State Governments to work with the specialist medical colleges on reforms to help eliminate the gap between the current Medicare schedule fee for surgery and random fees being charged by some surgeons that ultimately get passed on to patients as unexplained out of pocket costs.
  • The requirement for all fees and costs relating to surgery and in hospital stays to be provided up front and in writing as part of a pre-surgery quote provided to patients.
  • The requirement for patients to receive a second opinion and two written quotes prior to any surgery taking place, unless in an emergency.
  • The introduction of a standardised, industry wide fee explainer, outlining in plain English all costs that could be incurred by a patient prior to surgery or hospitalisation.

“It is standard for most professions to give a written quote to consumers prior to providing any service. Why should surgery be any different? Surgeons are experienced, educated and should, in the majority of cases, know prior to surgery what is involved and the cost. So why are we still hearing of so many cases of patients being handed a bill for excessive out of pocket costs as they are discharged from hospital?”

The APA said a successful precedent was action taken to halt real estate agent underquoting in Victoria that had gone on unhindered for years until the state government stepped in and required agents to provide a written statement of information with a quoted price range.

“As a result, excessive underquoting has stopped. Patients deserve the opportunity to be fully informed on not only their surgical procedure and expected outcomes, but the cost of that surgery and their stay in hospital.” Mr Riley said.

“We are encouraging patients to start to shop around and become more informed rather than just accept the first referral to a specialist or surgeon.”

“To use the house purchase analogy, a consumer wouldn’t normally look at just one house and purchase it without a comparison to other properties and looking at price comparisons in the area. For something as important as surgery, particularly when it can also severely impact your finances as well as your health, we believe it is even more important to get more than one quote.”

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