15th September 2020
MEDIA RELEASE
Greedy surgeons continue to line their pockets and overcharge patients.
The Australian Patients Association (APA) has hit out at greedy surgeries who continue to systematically overcharge patients. This has been brought to the APA’s attention by a mother who recently learned that she would be charged more than double the recommended fee for her daughter’s upcoming adenoid surgery.
While the Australian Medical Association (AMA) recommends a fee of $400 for the adenoid procedure, the mother will be charged an astounding $830.90 by the surgery despite having private health insurance. The patient’s private health insurance provider and Medicare will pay a combined $330.90 towards the surgery while the patient will be out of pocket by $500, which is more than the entire recommended AMA fee.
Money-hungry surgeries seem to have been doing this by cunningly taking advantage of “known gap policies”. Australian Patients’ Association CEO, Stephen Mason said that “These practices are abhorrent and amount to rorting and should cease.” By manipulating the system, surgeons have been able to get away with charging Medicare, private health insurers and patients the maximum fee possible which is, in many cases, hundreds of dollars more than the services are worth.
Mr. Mason has said that “Unfortunately, this is a common practice where the surgeon charges the patient the full out of pocket amount agreed by the health fund, within their “known gap” arrangements,”.
The graph below illustrates the astounding fee disparities faced by the mother of the patient.
Mr. Mason has confirmed that whilst “the mother doesn’t want to be identified because her daughter is yet to have the surgery, we have verified her claims that she will be out of pocket to the tune of $500, despite her having private health insurance.”
In addition, the receptionist at the doctors’ surgery told the patient’s mother that the software calculated the fees automatically, by accounting for the different rebates and gaps with different insurance companies. The ENT surgeon’s office also told the mother that the only time they charge a zero-gap or smaller gap than the maximum is if they have a special contract in place with a major insurer.
The mother of the patient has spoken out and said she feels cheated by both the surgeon and the private health insurance system. “Our family has private health insurance and we pay almost $6000 each year in premiums for hospital cover. My daughter now needs her adenoids removed.” Understandably frustrated, she continues; “I really don’t expect that our surgeon is twice as good as the typical surgeon and therefore able to justify charging twice the AMA fee. I think some doctors are taking advantage of this ‘loophole’ and ripping off patients.”
We encourage all patients to check the AMA recommended fee before they proceed with surgery in order to avoid excessive fees.
For media enquiries, please contact:
For further information: Stephen Mason, CEO, Australian Patients Association. Ph: 0408 944 859 email smason@patients.org.au