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ACT specialists requiring private hospital cover just to see you?

By poppy - 28 July 2011 13

My GP recently gave me a referral to an ACT specialist. The specialist’s receptionist refused to give me an appointment. She stated that I must have private hospital cover in order to see any of the specialists at this clinic. Confused, I questioned why I would need private hospital cover just for a consultation, when there is no reason to think I would need a hospital admission. In addition, if I did need a hospital admission or something that wasn’t covered by medicare, I do have sufficient funds to at least consider the cost of paying privately.

The receptionist wouldn’t budge. I now have to go back to my GP to try to get another referral. Leaving messages for my GP has resulted in no reply, so I will no doubt end up having to wait for and pay for another GP consult simply to get another referral due to the first referral being refused.

What is up with this? Why are specialists insisting on private hospital cover even when the referral doesn’t indicate a need for surgery/hospital admission?

I do have private health cover, but it is one of those useless policies that can’t be used for anything. The thought that I will have to pay for top notch private hospital cover just to get a consult with a specialist is frustrating and scary (how will poor people be able to see a specialist at all?)

This isn’t the first time I’ve had a receptionist deny me access to a specialist, am I just unlucky? How many others have paid GPs for referrals they can’t use? Why aren’t specialists communicating their requirements to GPs to minimise the cost, delays and frustration for patients?

What’s Your opinion?


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13 Responses to
ACT specialists requiring private hospital cover just to see you?
girliesmummy 9:20 am 03 Aug 11

Can anyone recommend a health fund that will actually provide a family with some decent benefits?

We’re a healthy family of 2 adults 2 kids requiring basic hospital cover with some extras: general dental examinations twice a year, the odd physio or chiro visit, that sort of thing….

We’ve been with MBF for years and are paying around $300 per month, for very little benefits in return. I realise all funds have probably been paring back benefits paid out over time but we’re now considering our options.

Jethro 9:53 pm 02 Aug 11

Ma Bodine recently went to the GP for a referral to get a test done by a specialist, and then went to get the test done only to be told that the referral didn’t have the details outlining what the specialist actually needed to do. Back to the doctor’s for another referral. This time the doctor didn’t know what test he needed to order or how to complete the referral. Half an hour and multiple phone calls later Ma Bodine received a new referral. Back to the specialist. Referral still not correct. Forty-five minutes and multiple phone calls later the test was done. She will need to have a similar test in a couple of weeks. The doctor refused to provide both referrals at the same time, meaning another GP appointment (and fee) will be necessary. What a strange and time-and-money-wasting system we seem to have.

masked 8:09 pm 02 Aug 11

I think you may have got the Calvary Clinic Sessional Rooms. These are run by Calvary Clinic who hope to that maybe patients will then be admitted to Calvary Private hospital. They are the ones who call the shots. I imagine the specialists are busy trying to see all the patients they already have.

On another note, much private insurance does not cover all types of hospital admissions. Psych and some cardiology admissions are examples…….but they offer you free movie tickets and running shoes instead! Read the fine print.

vg 11:24 pm 28 Jul 11

Probably a private clinic. I have private health cover. I was diagnosed with a ruptured ACL on a Thurs morning through MRI, jagged a specialist that afternoon, and had my knee reconstructed the following Tuesday. All because I attend to my own health needs through appropriate cover

jayskette 9:26 pm 28 Jul 11

I see my GP and specialists in Sydney. At least the 3 hours is spent DRIVING, not WAITING.

poppy 7:05 pm 28 Jul 11

Thanks for the replies. qbngeek, as far as I know the referral needs to be addressed to the specific doctor you are seeing, especially to get a medicare rebate. If that is not true then at least its what the doctors seem to expect. Anyway my doc hasn’t given me a copy of the referral, preferring to fax it to the specialist. I hear now that my referral has been faxed to another specialist who hopefully will accept my refferal, I just have to wait up to two weeks hoping for a phone call from the specialist to give me an appointment. YAY – no doubt I’ll hear nothing, end up chasing it up in about 2.5 weeks, back to the end of the queue again, perhaps I’ll see a specialist 12 months from now. I guess the doc doesn’t want me to see what they wrote in my referral thus I can’t pick the referral up and deal with it myself.

sepi, Canberra eye hospital are generally awful. They do lasik and cataracts and aren’t interested in much else. I was dumped by them and given nowhere else to go. Try to get in to the Canberra Hospital (ie the public hospital) eye clinic if possible, they don’t have the same attitudes and are much less quick to dump. I think you need to argue your case to get in, I had to find a good optometrist to get me in.

troll-sniffer 3:59 pm 28 Jul 11

What would happen if you just made up a private insurance cover or borrowed a friend’s and changed a digit or two?

Ernie 2:28 pm 28 Jul 11

Sounds exactly like the experience I had recently. We are able to see the specialist under public health in TCH, it’s just a longer wait. I complained about the receptionist being very rude and snooty because we don’t have private health and not surprisingly I wasn’t the first one to complain about her.

kschoey 10:52 am 28 Jul 11

I just had to get a new referral (decided not to go with original specialist). Called the GP, receptionist sent them a message, they prepared a new referral and I picked it up yesterday afternoon. No need for another consultation etc.

EvanJames 10:36 am 28 Jul 11

I’ve got private health insurance with a co-pay if you stay in hospital, but the co-pay is pretty small. I wouldn’t regard that as useless. I don’t bother with extras though, that just doesn’t justify the cost.

It is odd though, and the Sydney or southern highlands option is worth considering. I’ve used referrals for different practitioners too… I’ve asked when trying to book and never had a problem using a referral to another practitioner (in the same specialty, of course!).

The Frots 10:08 am 28 Jul 11

If you have a ‘useless’ private health insurance then perhaps that’s your first stop. Sort that out.

I have to say that while most specialists operate under the private health system, I haven’t come across this type of thing where they refuse to see you outright. It may be a new receptionist with ‘pit bull’ tendancies simply guarding the specialists interests without understanding the consequences.

So, I hope it works out for you. Another alternative, as inconvenient as it is, is to hit the highway north bound and get to Sydney.

Good luck.

sepi 9:43 am 28 Jul 11

I had a lot of trouble with Canberra Eye Hospital and referals.

Unfortunatley they are the only optometrists in canberra taking new patients, so I had to go through their rigmarole.More unfortunatley, the 4 month delay in getting an appointment, partly due to referral madness means it is more likely my baby will need an operation in future.

I got a referral to a dr at the Canb eye hosp. The receptionist was unbelievably rude, told me that dr had left and refused to provide any other dr’s names. She ordered me to go back to my dr and get a referral to the hospital, not addressed to any dr, (my dr wouldn’t do this), fax it to them (who has a fax these days), they would decide who would see my baby, and ring me back with an appointment.

I’ve never heard of such a byzantine system, and the whole idea of referrals is they have a specialist’s name on them. Not impressed, but sadly no other options in canberra for eye treatment.

Yet another medical area where it is difficult to see anyone at all in Canberra, let alone any9one good.
(Actually when we finally got there the dr was good. But the delay has been detrimental.)

qbngeek 9:09 am 28 Jul 11

WHy do you need a new referral?? In the past I have taken a referral to a doctor other than the one it was made out to and it has never been an issue. As someone who deals with doctors and specialists all day, I go to the ones I know are good, not the ones my doctor tells me to see.

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