Extortionate Specialist Fees

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  PcisT on 15/05/2013 - 19:38

  It's always worth asking if they can reduce the price.

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  epicaricacy on 15/05/2013 - 20:09

  +2

  my plumber just charged me 120 to clear a drain, for 20 minutes work, which involved sticking a long tube down the drain, watching it, then dragging it back out. that's 360 an hour…. and I bet he doesn't have the years of training or insurance fees of this guy!

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  ipster on 15/05/2013 - 20:14

  +4

  My 2 cents.

  1.My bathroom needs a new inline duct fan. Electrician's quote $200 for fan (researched RRP $160) + $200 labour = $240 for 30 minutes work. No medicare rebate

  2.Scheduled fee = gross misrepresentation by the government of what value of medical services should be. Current version of commonwealth medical benefit schedule (CMBS) laid out in 1984 with advent of medicare and then subsequently "indexed" annually to 2% or less for last 30 years. young_dazza, imagine getting paid at the same hourly rate in 10-15 years time for what you get now, and you would then understand why no specialist doctor charges the scheduled fee for all patients.

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  johnnyb on 15/05/2013 - 21:28

  +1

  This is OzBargain- get a referral to your closest public tertiary hospital's outpatient clinic for the particular specialty and be seen for free.

  May have to wait a year though, depending on what it is. And may see a registrar (training specialist).

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    May4th on 15/05/2013 - 21:58

    good idea if it's not urgent and not causing you substantial grief. the outpatient clinics are largely run by registrars (trainee doctors) with consultant supervision, so depending on your luck and the registrar's seniority you may or may not get your questions answered satisfactorily. sometimes you won't see the specialist at all.

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  Frugal on 15/05/2013 - 22:12

  +3

  Wow… This topic sparked a massive response.

  Being a doctor is a highly stressful profession and the amount of energy to go through their training. It's not all fun and games. They can have their Porsches.

  Give me a ozbargain any day!

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  srhardy on 15/05/2013 - 22:39

  +1

  The guy that serviced my stove made $120 to just turn up, which he had to do twice + parts and workmanship - total was almost $500 for less than half an hour in total… He didnt have to have the insurance that a doctor has to pay, the huge HEX debt as it was a tradeship where he earnt and my life wasnt in the blance unless he messed up the earth in the wiring… $225 and less than $100 out of pocket is cheap & thats if he was doing almost anything other than being a doctor with wages and staff/training… I would pay it in a heart beat and if i thought it was urgent, extra to be seen right away and for a second opion & i am the poorest, scrooge in the world (take my word for it, i am though)

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    May4th on 15/05/2013 - 22:44

    if your financial situation was so fraught you really could not part with that $200 i think the majority of specialists would bulk-bill you. good luck trying that with your plumber though :)

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      [Deactivated] on 16/05/2013 - 13:02

      +2

      what you think and what happens in practice are two different things

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        May4th on 16/05/2013 - 13:38

        there are two rates, the AMA rate indexed to inflation and wage growth etc that doctors should be paid, and the bulk-billing rate. most doctors stick to a figure within these two parameters. my mother has seen multiple specialists ranging from ophthals to OGs and she has never been charged more than 260 before rebate

        like said before you can always see specialists in hospital outpatients for no fee

        care to share what your illusion of reality is?

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        [Deactivated] on 16/05/2013 - 21:40

        Unlike your broad generalisations and quaint/rose-coloured views of our health system my observations are based on experience - both my own and that of many others. If you don't fit the standard mould for bulk billing you will generally be charged the specialist's full rate, that is if you can get a consult at all, as in parts of this country specialists and GPs are hanging out no room at the inn signs - they can't cope with demand already and are working ridiculously long hours. Some specialists, probably most, and GPs are well worth their fees and as some have already pointed out above they generally provide far more value and expertise than do tradesmen for example. That is yet another case of supply and demand leading to market overpricing. The health system is already suffering from increasing and ageing population and policy makers need to be considering new paradigms for health services.

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        May4th on 16/05/2013 - 22:18

        i don't understand why you are arguing with me seeing we have the same view point

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        [Deactivated] on 17/05/2013 - 13:22

        +1

        Judging by your comments above we are worlds apart. You think the health system is working well under the current systems of qualification and control, I think it requires a major rethink if we are to cope with future demands. Changes take a considerable amount of time to work through a system as complex as medicine/health care so we need to be acting now, not treating the problem after it eventuates. That is how we got to where we are now. the Labor government went some way down the path of improving medical service delivery through it's introduction of health centres staffed by health professionals to deal with "routine" problems. There needs to be far more thinking and action along similar lines to open up the profession to people who may not be in the top 1% of academic achievers.

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        May4th on 17/05/2013 - 15:05

        +1

        where did i say i was happy with the system? i have drawn attention to all of the problems you listed in my comments above. maybe you should re-read them. or read them.

        as a summary:

        we are where we are now because govt in the 80-90s drastically cut medical school numbers, and we are overcompensating for it now with a tsunami of new grads but not enough advanced trainee spots to make them into specialists and GPs. the problem is that advanced trainees need to have specialists to supervise them - but there simply isn't enough of them so our capacity to increase training numbers is severely limited. this is where the bottleneck is and why we are importing foreign specialists while having flood of medical graduates and not enough intern spots. it has nothing to do with increasing intake to more than the top 1% achievers - or you could say it's already happening.

        most people think along the lines of more doctors = we need more medical school numbers = open up more spots. this however exacerbates the problem where we waste millions of dollars putting students through medical school only for them to have no training spots later in their career. this has nothing to do with demand and supply and will not bring the cost of healthcare down.politicians have resorted to opening up spots because it's an easy solution which the public will buy and universities are a powerful lobby group and opening up new spots/schools = $$$$ for them

        and fyi entry criteria these days into medicine is usually multimodal with academic achievement playing only a part in conjunction with interviews and the UMAT (which tests empathy as well as logical reasoning)

        and like i said before, we are moving to delegate jobs which require less training towards non-doctors such as nurse practitioners. this is nothing new, this has been put in place years ago. but you need to recognise someone needs to make a decision regarding what can be seen by less trained professionals to doctors - what seems like a cold and a sniffly nose could be an insidious onset of life-threatening illness. it's a slow and difficult process trying to explore new options while making sure we are 100% safe and accountable. when it comes to health, even 1 morbidity or fatality is a failure of the system as we have seen in the news

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        [Deactivated] on 20/05/2013 - 17:50

        100% safety in medicine is absolute nonsense and if you think that our system is anything like that you're both naive and delusional. You only hear about the worst medical malpractice cases in the media. There are thousands of cases, probably tens of thousands, of incorrect and indifferent diagnoses by GPs which go unreported, undocumented, and unchallenged by users of the system. High marks and years of training doesn't guarantee anything, and it sure doesn't guarantee good doctors.

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        May4th on 20/05/2013 - 19:29

        read my comment again. in fact, read every comment again

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      Frugal on 18/05/2013 - 21:05

      I dont get why patients gripe about paying for their health yet puts up with the cost of servicing their car

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        young_dazza on 18/05/2013 - 23:32

        If you went to a mechanic and he spent 10 minutes in a chair listening to your complaints about your car, said come back in 2 weeks if youre not feeling better then charged you $250, you might take that to fair trading.

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        May4th on 19/05/2013 - 10:13

        i find the most important factor with patient satisfaction is doctor communication. while most if not all specialists are qualified in their jobs the old-school and older generation of specialists especially tend to seem a bit aloof and don't explain everything which may cause the patient to hold grudges. i'm sure he could have explained why he was waiting 2 weeks, of the things it could be etc

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  tonester on 15/05/2013 - 23:01

  Can you suggest a way to get treated by a specialist who's not going to rip me off in order to finance their luxurious lifestyles?

  public hospitals often have bulk-billed specialist outpatient clinics :)

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  adhin on 15/05/2013 - 23:54

  +5

  Just be thankful that you have access to Medicare and enough wealth to be able to afford to be part of a health fund.
  Hopefully by the time you become old_dazza you will have gained some perspective.

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    young_dazza on 16/05/2013 - 14:30

    lol! Its true that healthcare costs a lot and the government foots most of the bill. I wonder if the govt didnt cover any of the costs whether the specialists would charge the same fee, or whether they'd lower it to a price more acceptable to the market?
    It reminds me of when the Howard govt increased childcare rebates and most childcare centres increased their fees by the amount of the additional rebate.

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      adhin on 17/05/2013 - 06:57

      +1

      The same could be seen with house prices when the first home owner grant came in.
      I wonder if TV prices will drop now that the baby bonus has been scrapped.

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  leiiv on 16/05/2013 - 00:09

  Does bulk billing mean that no gap is paid at all? Is there any specialist that bulk bill?

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  leiiv on 16/05/2013 - 00:41

  The problem is that healthcare is considered as a basic necessity. I can choose not to eat luxurious food and live, but can I choose a cheap doctor and be healed? Our public school is free, why can't the healthcare is free too?

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    johnnyb on 16/05/2013 - 00:53

    +2

    As mentioned above multiple times, outpatient clinics in public hospitals are 'free' (in that you pay via your Medicare levy- if you pay it).

    If you choose to go private, you pay extra.

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      young_dazza on 18/05/2013 - 23:37

      It seems that outpatient clinics arent 'public' knowledge.

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  susmind on 16/05/2013 - 00:57

  -2

  I had pains all up and down my legs, referred by GP to the orthopedic specialist who had no idea and sent me to radioactive injection Xray at $$$ and still had no idea !

  My ozzie LIGHTWEIGHT BOUNCY boots then made in China but Chinese couldn't do it like ozzie manufacturer and lightweight boots fell apart.
  Wore heavy STABLE boots and 2 weeks later pains in legs disappeared, result doctors are hopeless.

  If you have pains in your legs the first thing a doctor should consider, considering that everyone in first world wears footwear is, DO YOU HAVE ANY DOUBTS ABOUT YOUR FOOTWEAR ?

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  thepigs on 16/05/2013 - 14:17

  Ask your GP for a list of specialists so that you can shop around. I needed a surgeon and I found one who had a nurse do the initial consult at no charge, and everything was picked up by medicare (if you don't mind waiting a year).

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    wanderingoz on 16/05/2013 - 14:45

    Also ask your Health Fund if they have agreements with any particular specialists in the field. You will often find a GP doesn't really care which specialist they refer to.

    Any with an agreement with your Health Fund will usually be cheaper.

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  YTW on 16/05/2013 - 14:42

  Of all the medical costs I have to pay out of pocket, I usually find the specialist's fees the best value. I have had some excellent advice and been very satisfied with the various specialists I've seen (Allergist, Orthopaedic surgeon, General surgeon, Ob).

  It's the GP's fees that annoy me. $35 out of pocket for them to glance at your child and then throw you out 5 minutes later with a 'come back if it gets worse' only to have to return the next day and pay again. I could go and sit for over an hour with a sick child to get seen by a bulk-billing GP to save the money I suppose :/

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  giggles on 16/05/2013 - 14:57

  +2

  The answer is: become a specialist and share in the spoils.

  If you really want expensive, then try having a condition that has no specialist in Oz at all, and your only option is to go to the USA and pay all fees yourself with no hope of claiming 1 cent back ever. This is the situation a friend of mine has found herself in with a genetic condition.

  To be the Devil's advocate, I guess we should be thankful we have access to the specialists and practitioners that we do have. It's pretty cheap to die of a curable or treatable condition in India etc.

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  Almost Banned on 16/05/2013 - 16:04

  The cost is only part of the issue.
  My daughter just went to a dermatologist a couple days ago.
  She had to wait for more than an hour after her scheduled time to get in - she was in there for 5 minutes tops, then it cost me $85.
  Sheesh.
  The time wasted is at least as outrageous as the cost IMHO.

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    giggles on 16/05/2013 - 16:54

    MANY specialists run late. My daughter had to wait 2.5 hours overtime to see her dermatologist (I was amazed she made the distance). And yes, she was in there about 7 minutes.

    The fact is that we can't write prescriptions for children's cortisone ourselves.

    I would only complain if the cream/ointment prescribed had no effect. THAT would be a miserable outcome.

    I personally find the most annoying thing about some practitioners is when they can't speak intelligible English. Sometimes their mumbling seems deliberate as they hope you will just nod to something you didn't quite understand, which was ambiguously worded anyway.

    At least we don't have to wait or line up to buy food or toilet paper here…..yet.

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      jeffjj on 17/05/2013 - 09:34

      I hope the people complaining about waiting are not the ones who beg receptionists to "squeeze in" their loved ones to be seen- "squeezing in " extra patients simply means that everyone else waits. Also remember that the only way to guarantee that the doctor does not run late would be to eject the patients from the consultation when their "time is up"- bad luck if the problem is not sorted out yet!

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    tooblue on 16/05/2013 - 20:37

    -1

    Here is some people's logic: More doctor -> mistreatment, so we should limit the number of doctors to a minimum level.

    You should be thankful, the longer your daugter waited the less possibily she would be mistreated.

    Of course there are many people who couldn't afford to wait, that's their own bad not the system.

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  jeffjj on 17/05/2013 - 09:31

  In my experience price and competence are not at all correlated in medical practice in Australia…IMHO many doctors simply charge what they can get away with, whilst looking over their shoulders at their lawyer/banking/business buddies who often charge more to do work which has far less responsibility attached than say a surgeon- an error can mean a medical disability or worse for medical specialists and even GP's..

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  shazfx on 17/05/2013 - 14:08

  +1

  Hi,

  I experienced the same when enquiring about the fees for a specialist prior to getting the referral letter.

  The nephrologist who is listed as number 10 or sumthin in the Royal Melbourne Hospital list of specialists was gonna charge me $400 for first consultation. Then $280 for subsequent. This was the fees I got from his private office where he treats patients outside of his working hours at RMH.

  of course the medical coverage / MBS fees that I will get back is what is published online which is $120

  So what I did was,I called other specialists from the same list, going up the ladder to the more experienced ones and seems like the more experienced they are, the cheaper it is.

  So what I suggest u to do is…
  a) Define what type of specialist u need.

  b) Find the website of the local hospital near you, lookup for the list of specialist in the category that u need. Usually its listed as Head of Department and list goes on from most experienced to least.

  c)Google for the specialist private practice clinic number, call and enquire fees.

  d)Compare their fees with the MBS published fees online, u can see how much is subsidized and how much u have to pay.

  I did these steps and got top 3 specialist in Melbourne's RMH private wing for same amount of mbs published fee. I got either 85% of my money back or 100%

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    young_dazza on 18/05/2013 - 23:39

    Some good tips there, thanks

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  StewBalls on 17/05/2013 - 16:17

  …the specialist is charging $225 for a 30 minute consultation, and Medicare's "scheduled fee" for the service is only $128, so I'll need to pay $97 out of pocket.

  You should try getting a plumber nowadays, they'll want at least that per hour…no medicare for the bastards either…they're like Naomi Campbell, the won't get outta bed for less than fixed fee! :s

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    young_dazza on 18/05/2013 - 23:45

    I agree. Finding an honest tradie whos not trying to rip you off at every opportunity can be difficult. When you find an honest one you stick to 'em.

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  chiefbodge on 17/05/2013 - 18:08

  Bulk billing amount can't be that bad as 81% of GP visits are bulk billed http://www.abc.net.au/news/2013-05-13/bulk-billing-rates-rea…

  They get $36.30 per consult. Most patients they can get in and out in 5-10minutes so that's $216/hr at worst. And if you need a nurse they can bulk bill you another $39 (I think). Plus there are lots of items they can bulk bill you for as well. IMHO the system works. I think it's great that bulk billing rates are so high.

  As far as specialists go, fair enough if they don't want to bulk bill but if you shop around you can lessen the gap or perhaps even find some that do. Through my limited research I did see that some obgyns bulk bill so I would assume the same applies for other specialists. I found that in medicine prices vary hugely. Like To get my impacted wisdom teeth out (4) cost me $1200 total but I have heard people paying anywhere from $900 to $2000 for the same thing (in the chair not in the hospital).

  The referral deals that GPs have going with specialists is a bit dodgy IMHO. Some doctors will either automatically give you multiple referrals or you can ask them to do so though. My dentist understood that I didn't have a lt of money when I was a uni student so gave me 3 referral letters and said to ring each one and ask the price and then post the one that was the cheapest - I thought that was great.

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    May4th on 17/05/2013 - 19:20

    it differs a lot between individual GPs and it's a good idea to shop around to find one who suits you. some are very rushed and literally shove you out the door while others can take their time, i know a part-time GP who have appointments for 3 patients per hour. the average and recommended consult is 15min but for the complex patients it can take an hour (i believe bulk billing rate for complex consult is $110 with a 40minute min. consultation time)

    and yes like said above, if you are not happy with the fee, shop around

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  jeffjj on 17/05/2013 - 21:22

  +2

  Item 23, ie standard consultation fee for a GP is $36.30 I think and there is a $6 extra if the patient is on a health care card.
  Even if the GP really pushes it, it is difficult to properly see more than 5 patients per hour ( considering interruptions, paperwork etc). So the max would be $200/ hr billed. But then in most cases the GP will only receive around 60% of this, say maximum $120/ hour. And as has been mentioned by others, many tradies charge similar rates.

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  C-Nut on 18/05/2013 - 11:58

  +1

  ~$100 out of pocket to see a medical specialist is not unreasonable. As others have compared to already, tradespeople cost just as much, if not more. "Labour", ie: a person's time working, costs a lot in Australia. How much training, intellect, time and effort do you think it takes to become a specialist?

  We are lucky in Australia, that we have Medicare, otherwise you would have had to pay the FULL $225 without any subsidy. Medicare's schedule/published fee is not intended to be a guide for what specialists charge, but is really the amount that the government is happy to subsidise you for your medical care. In the US, you wouldn't even get treated in hospital without private health insurance.

  If you don't have enough money to pay a specialist, you can always ask to be referred to see a specialist in the public health system (which is provided at no-cost). Of course, you will have to wait to get an appointment, will likely have to wait for hours on the day of your appointment, and may be seen by a more junior doctor.

  Bulk-billing, especially by GPs, probably degrades medical care. As mentioned in this thread, GPs earn $36 per patient when bulk-billed. I don't think I could see any other professional (non-medical) for so little money. So I am not surprised when bulk-billing GPs only give you 5 - 10 minutes of their times per consultation.

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    StewBalls on 18/05/2013 - 12:05

    +2

    Whilst I agree with the majority of what you're saying here; I strenuously object to this:

    Bulk-billing, especially by GPs, probably degrades medical care.

    We NEED to have accessible primary health care for the more vulnerable members of our society…period!

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      May4th on 18/05/2013 - 13:09

      +1

      unfortunately our economy can no longer afford the huge cost of healthcare which is why medicare schedule fees, and hence doctor's pay have been decreasing in realistic terms for decades.

      because healthcare is a basic human need, and an entitlement to most of us, the free market principles of demand and supply does not apply. tradespeople and miners can jack up the fees as much as they like as long as there is a market for it, but for doctors to do so there would be an uproar, and rightfully so.

      there will be a time when our economy simply can't afford medicare and we are heading down the treacherous path towards an american system where private health insurance is everything and people are left in the gutters if they don't have the money to pay for healthcare

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        StewBalls on 18/05/2013 - 15:15

        Nonsense, a sustainable medicare system is perfectly feasible in a developed country like Australia. Sure, the current one might need a little bit of tweaking after some 40+ years, but it's one of those social frameworks that we simply have to budget for, lest; as you rightly point out; we go down the road of the shameful American model of wholesale user pays! Remember, just because a particular social resource costs money, doesn't necessarily make it an unsound long term investment…particularly with our aging population…spend a bit now on prevention, reap the savings in the long run.

        It is noteworthy that the US has long acknowledged the disparities of their system, and have at least attempted to enact "Obamacare" to level the playing field, but their convoluted incumbent system is hampering efforts considerably AFAIK. OTOH, we already have a workable model, no need to throw out the baby with the bathwater here…just put the requisite effort into streamlining it.

        You also can't blame Medicare for the results of ultimately piss-poor economic management, there's a hell of a lot more sites of fiscal haemmorhage to address before you go pointing the finger at healthcare. I can assure you, working in human services myself, that primary health care isn't where the majority of the waste is…I have the 'joy' of seeing appalling wastes of taxpayer dollars on a daily basis in community settings that never see a penny of direct Medicare funding!

        FWIW, Medicare schedule fees are just part of the natural checks & balances necessary to keep it sustainable…otherwise it would become a free-for-all. Simply writing them off as some sort of knee-jerk reaction to escalating health costs is drawing a pretty damn long bow.

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        May4th on 18/05/2013 - 15:51

        +1

        i think you missed my point, i said none of the things you think i said.

        i'm not denying the need for sound fiscal planning but the fact of the matter is health care costs have been rising as people increasingly lives longer and our population ages. statistically government spending on health has increased from 10-20% of total spending decades ago to more than 50% this year, and this trend will only worsen.

        so yes, you are right in a sense. declining schedule fees are only an indicator of the increasing burden our economy is bearing

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        StewBalls on 18/05/2013 - 18:17

        i think you missed my point, i said none of the things you think i said.

        Seems so…maybe I've been trying to do too many things at once today, even for me! ;)

        That said, the cost of everything is going up…I can't actually remember when it went down in real terms…it costs ever more to live, it stands to reason that it's gonna cost more to stay healthy. We budget for increases in all other costs of living infrastructures, why not allow more for a reasonable healthcare budget.

        Where are you getting those figures? 50% of total domestic spending on health alone doesn't sound quite right to me? You also have to remember that health =/= medicare; allied & community health are also fairly substantial burdens on the taxpayer. Recent governments have already attempted to offload some of the burden on the public system by providing tax incentives for those in private health funds, and IIRC announced plans to streamline Medicare, so there are moves afoot to tier the system to some degree (hopefully in favour of the needy…personally, I'd like to see it means-tested).

        So ultimately, yes, it's a financial burden…but a necessary one ethically & morally, and provided that it's administered right, one that hardworking Aussies should be proud to support. However, it is not the gaping wound you seem to think it is, there are far bigger wastes of the taxpayers dollar than providing accessible medical services!

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        May4th on 18/05/2013 - 19:37

        allied health and community health are partially funded by medicare :) and i'm fairly confident about those figures although i don't have a link for you, but it's 50% of revenue and not GDP which is on another whole different scale.

        and i think i've said too much without really making any particular points.. i don't know how it happened :P

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  [Deactivated] on 18/05/2013 - 14:43

  +3

  A bloke calls a plumber to unblock a pipe. The plumber comes, inspects the pipe, gets a hammer and whacks the pipe with it. The pipe unblocks instantly.

  "That'll be $150.00, thanks", says the plumber.

  "What", exclaims the bloke, "$150.00 just to hit the pipe with a hammer?"

  "It's not about hitting the pipe with the hammer", replies the plumber, "it's knowing WHERE to hit the pipe with the hammer".

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    May4th on 18/05/2013 - 21:28

    but there's only so many places on a pipe that you can hit with a hammer :P

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  DealzEddy123 on 19/05/2013 - 04:17

  when I broke my nose, the specialist charged me ~300 for a 15 minute consultation to tell me it was broken, then another 3k in surgery and hospital fees to get it straightended lol

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  thetownfool on 19/05/2013 - 10:38

  +5

  As someone on specialist training, it's a long, hard, expensive and tiring road. Right now my wife has taken my 5 month old child to the in-laws for the weekend so I can study. The public system works and, despite what the papers say, generally offers a very high level of health care. If you want to been seen or operated on faster, or by someone specific, you can pay more - that's the private system and I think most people prefer to have that option.

  If you think health care costs too much, look up the stats for how much is spent on patients in the last 12 months of their life, or even in the last month. Then consider what could be done to cut this down. If you think just training more doctors is the answer, ask yourself how they're going to learn with the same number of patients and teachers.

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  MITM on 19/05/2013 - 22:30

  Treat the 1st consultation fee as a "call-out" fee a plumber or electrician would charge - regardless of what they do (perhaps change a fuse you couldnt find for $50 + parts + $100 call-out fee.)
  At least you get $128 back from medicare - zilch for the plumber.

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  Whodis on 18/06/2013 - 13:50

  No one EVER thinks they pay too little for their healthcare. More than anything though, you just need to feel like the money you just paid added value to your life, but unfortunately in the age of the internet, everyone feels like they are Dr Google MBBS, so value adding by health care practitioners is difficult, given everyone already knows what they have and how to treat it.

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