Exorbitant specialist fees in Canberra … what’s going on here?

birder 18 July 2012 23

I needed to see a specialist (ob/gyn) last month, and the cost was $250, with medicare reimbursing only $70. That’s $180 out of pocket for a 15 minute appointment. My partner had to see a specialist (gastro) this month, and it was $325 for a 10 minute appointment! (I’m guessing that medicare will reimburse $70 also for this appointment.)

My question is, how the heck do people pay for these appointments? My partner is in school full time, so this comes straight out of savings. But what about young people with no savings, or people who are managing paycheck to paycheck? Have we just accidentally stumbled upon outrageously expensive specialists, or is this the way it works in Canberra and/or Australia?

By way of comparison, specialists in NZ were expensive but my private health insurance reimbursed me in full. In the US, I had good health coverage and I had a $50 copay for any specialist visit.

I’m just shocked at the cost for these appointments and frankly wonder how this is affordable to anyone who isn’t wealthy. Do you just skip doctor’s visits? Wait until it becomes an emergency and go to the hospital? Or am I just cheap and this isn’t seen as expensive at all?


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23 Responses to Exorbitant specialist fees in Canberra … what’s going on here?
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frisky frisky 2:37 pm 21 Aug 15

I decided to have gastroscopy and endoscopy as a routine check. I was offered a free initial consultation with a nurse or one with the surgeon for $450. Not a hard choice, although I would have appreciated a brief discussion about my symptoms. $450 seems outrageous for a consultation.

What really annoys me is that I have been booked into Eqinox Building with “ACTendoscopy”. They still have not reached an agreement with my Health Fund, and thus they expect me to pay an extra $500 on top of the usual $100 excess.

I am now trying to find which endoscopists work in other hospitals and have this routine examination done there. Why the hell do these endoscopists work in hospitals that are not registered with the health funds and then try to sneak the costs onto the patients.

The same happened to me two years ago for the same reason. I paid up last time but will not do so this time. I do not know whether the problem lies with Medibank Private or with Equinox. I am investigating and will update this site to reveal who is responsible for this rip-off.

wildturkeycanoe wildturkeycanoe 8:43 pm 14 Jun 14

Recently I had the misfortune of doing some serious damage to my calf muscle whilst near the mall. I did the correct thing and went to the doctor’s clinic rather than the hospital [because I couldn’t walk properly and it was the closest place I could hobble to]. After the usual wait, the doctor took a look and sent me straight to the emergency department as the surgery didn’t have the right equipment to detect whether it was a total rupture or just a strain. So, I got myself to ED and waited the normal period, had it assessed and booked in for an ultrasound. So far, not a cent out of my pocket except for the crutches they sold me [which I got to keep thankfully]. Anyway, by the end of the day the results weren’t conclusive so I was referred to a specialist across the way. Apparently it was urgent I get it looked at so we went there straight away. For some reason they were closed an hour before they were supposed to so I waited till the next day. First thing next morning, I found out I couldn’t get in for another two weeks and they weren’t available that day either. I was given the number for another specialist across town and due to the fact my entire leg was so cold it was almost going blue, they took me in straight away. A quick exam revealed nothing catastrophic, but still I’d be out of action for a while and to go back if things didn’t improve in a week. The consult was to be $180 out of my pocket and if an MRI was required, who knows how many hundreds and how long the wait. Thankfully I was given a discount and we had just enough in the bank to pay it, but only received half back.
Through this whole experience, I came to realise that if there is something life-threatening like compartment syndrome or DVT [common for calf injuries], or worse things which require further testing and diagnosis by professionals, if a person doesn’t have any money to pay for these tests they’d end up possibly dead because they are too poor to get the right medical care. When health is tied to a persons financial status, it sucks to be poor. It is truly a frightening thought that lack of money can lead to your own premature death when there are readily available treatments and cures that could save your life.

aaa123 aaa123 4:23 pm 14 Jun 14

PrinceOfAles said :

Now I have never seen a specialist until recently so I really don`t know how it all works but I was referred to a urologist at TCH by my GP. I`ve seen him once and it hasn`t cost me a cent. I don`t have private health insurance or a health concession card of any kind. Can anyone explain to me why it didn`t cost me anything if other people are paying $200-300 per visit to other specialists?

Because you were referred to a specialist at a public hospital. Public hospitals are mostly “free” even for outpatient services. However, not everyone can visit specialists at public hospitals due to criteria about which patients they will accept, as well as potentially even longer waiting lists than private specialists.

PrinceOfAles PrinceOfAles 9:46 pm 13 Jun 14

Now I have never seen a specialist until recently so I really don`t know how it all works but I was referred to a urologist at TCH by my GP. I`ve seen him once and it hasn`t cost me a cent. I don`t have private health insurance or a health concession card of any kind. Can anyone explain to me why it didn`t cost me anything if other people are paying $200-300 per visit to other specialists?

HiddenDragon HiddenDragon 7:06 pm 13 Jun 14

I’ve had similar experiences with getting back a rather small proportion of what it’s cost for specialist consultations and procedures. I don’t think they’re “cheap” anywhere, but with so many things, prices in Canberra seem to reflect the much higher than average household incomes here.

Would it be possible to have a thread on things which are cheaper here than in other cities…..?

74Daizies 74Daizies 1:40 pm 13 Jun 14

birder said :

FioBla said :

I couldn’t tell from the original post that birder had private health insurance in Australia. AFAIK, specialist consultations “should be covered”. I put that in apostrophes, because this is a relationship between your insurer, and the specialist. And you. And what the specialist decides to do in terms of charging.

I have to say that I didn’t understand all this either, until having to go through a couple of procedures. Aside from the safety net, you want to look up gap/no-gap treatment, and know what your private insurance covers (there are many packages, and many providers).

I have not been in Australia for very long, but I am 95% positive that you are wrong. Private insurance does not cover specialist visits – only hospital coverage and “extras.” My ob/gyn sent me a letter and it said “Private insurance will not cover this visit.” I called BUPA (my private insurance provider) and complained that they did not cover specialist visits. They said, “No private health insurance in Australia covers specialist visits.”

If I am wrong, please let me know. We would drop BUPA in a second to sign up with a private health policy that covered specialist visits. But I am pretty sure that I am not wrong.

You’re not wrong. Private health does not cover specialists. … and I would argue that they barely cover anything really. I am currently out of pocket just over 10k for RME and Braces and will IN TOTAL get back $2000. Yup, worth every cent of the $300+ per month

Monomyth Monomyth 12:58 pm 14 Aug 12

I’ve had to cancel a couple of specialist appointments because I was unable to pay for them. Currently at home sick, unable to go in to work – so I’m losing money now by not going in.

Pretty depressed about it to be honest – so I know how you feel.

birder birder 1:24 am 20 Jul 12

FioBla said :

I couldn’t tell from the original post that birder had private health insurance in Australia. AFAIK, specialist consultations “should be covered”. I put that in apostrophes, because this is a relationship between your insurer, and the specialist. And you. And what the specialist decides to do in terms of charging.

I have to say that I didn’t understand all this either, until having to go through a couple of procedures. Aside from the safety net, you want to look up gap/no-gap treatment, and know what your private insurance covers (there are many packages, and many providers).

I have not been in Australia for very long, but I am 95% positive that you are wrong. Private insurance does not cover specialist visits – only hospital coverage and “extras.” My ob/gyn sent me a letter and it said “Private insurance will not cover this visit.” I called BUPA (my private insurance provider) and complained that they did not cover specialist visits. They said, “No private health insurance in Australia covers specialist visits.”

If I am wrong, please let me know. We would drop BUPA in a second to sign up with a private health policy that covered specialist visits. But I am pretty sure that I am not wrong.

snoopydoc snoopydoc 12:02 am 19 Jul 12

EvanJames said :

The worst thing is how you have to waste money on a GP before you can get medications, or a referral to see a specialist.

I was musing on relative value this week. $70 to see a GP for 5 minutes to get a repeat prescription for some anti-inflamms for my back. $80 for an hour with a physio who is actually fixing the back. Since when did a GP fix anything? It’s tick and flick, for an exhorbitant price.

The physio is amazing value, they’re actually fixing something. Same price, pretty much, 5 minutes vs an hour. It’s wrong.

GPs can fix a lot of things… but if you’re being charged $70 for a 5 minute “pick-up-a-script” visit you are well and truly being shafted. I’d chat to your GP about it and if they’re not willing to compromise on that sort of visit, you’d be better off finding a new GP / surgery.

With regard to specialist fees, typically you’re charged a higher fee for the initial consultation ($200-350) and then a lesser fee (should be about half but rarely is) for subsequent consultations. If it’s a run-of-the-mill office/rooms consult (no procedures or investigations) and you’re more than $100 out of pocket, you’re being shafted by a doctor who charges more than they should for their services.

FioBla FioBla 8:16 pm 18 Jul 12

I couldn’t tell from the original post that birder had private health insurance in Australia. AFAIK, specialist consultations “should be covered”. I put that in apostrophes, because this is a relationship between your insurer, and the specialist. And you. And what the specialist decides to do in terms of charging.

I have to say that I didn’t understand all this either, until having to go through a couple of procedures. Aside from the safety net, you want to look up gap/no-gap treatment, and know what your private insurance covers (there are many packages, and many providers).

Madam Cholet said :

Have to agree. I have recently seen an ENT and whilst his fees were bearable with the rebate, I did feel that I was only ever going to get the 20 minutes they allot you and no more….not sure how they ever run late as I was in and out in the specified timeframe on both occasions. To boot, having booked in for an op it seems to me that there are very few surgeons/specialists who actually subscribe to gap cover. Why is tht? This op if I go ahead with it will cost me 2k out of pocket – that’s after the rebates.

Madam Cholet said :

Back on specialists though….has anyone noticed that they all seem to employ Rottweilers as their receptionists? No one is going to get passed those ladies! The last specialist I saw had no email or web access in his office so you had to either take any paperwork in by hand, post it or god forbid fax it. Surely on their Salaries they can stretch to email?

Well, the government does have (huge) intervention in the health industry, mainly acting as a large insurance company in the form of Medicare. But ultimately, the price that specialists in private rooms charge is affected by supply and demand. i.e. scarcity, competition, richer Canberrans etc. Same factors affecting other professions. And then there’s the cost of private equipment, operating rooms, etc. Specialised equipment, just like in other professions.

Some other threads that may be useful: http://the-riotact.com/how-much-does-it-cost-you-to-go-to-the-dentist-in-canberra/42520

http://the-riotact.com/tag/doctors

blimkybill blimkybill 4:51 pm 18 Jul 12

I have found Canberra specialists to charge a lot more than specialists I have seen in other (regional) areas.

The Medicare safety net can be a lifesaver. You can find out more information here: http://www.humanservices.gov.au/customer/services/medicare/medicare-safety-net

Once you have spent the threshold amount on out of pocket medical services, you get back the medicare amount plus 80% of your out of pocket costs. It makes the whole thing doable for average families/people who need to see a specialist more than once or twice. The threshold is much lower if you are a family with children who qualifies for FTB. For me (sole parent) one visit to a very expensive specialist for my daughter, plus 3 or 4 GP visits, took me to the threshold.

I think people on low incomes either avoid going to specialist at all – either going without treatment or goin g to a public hospital clinic – or perhaps some specialists will charge lower for health care holders.

EvanJames EvanJames 4:49 pm 18 Jul 12

The worst thing is how you have to waste money on a GP before you can get medications, or a referral to see a specialist.

I was musing on relative value this week. $70 to see a GP for 5 minutes to get a repeat prescription for some anti-inflamms for my back. $80 for an hour with a physio who is actually fixing the back. Since when did a GP fix anything? It’s tick and flick, for an exhorbitant price.

The physio is amazing value, they’re actually fixing something. Same price, pretty much, 5 minutes vs an hour. It’s wrong.

birder birder 3:47 pm 18 Jul 12

Thanks everyone. What is the threshold? Once we spend a certain amount, we get more back from medicare? Do we have to register for this? I’m sorry, but I do think a 10 minute appt with a gastro (and no examination, just sitting behind a desk, talking, and then recommending a colonoscopy is CRAZY expensive at $325. What really bothers me is that there is no way to get any of the money back (except the $70 from medicare). Someone mentioned the dentist – but you can get your dental covered through private insurance. I’m with BUPA and just had X-rays, cleaning and fluoride for $40 total out of pocket – with a great dentist. In both NZ and the US, specialist fees are covered by health insurance. Does anyone know why specialist fees are not covered by health insurance in Australia?

Thanks for helping me understand the system better – we’re going to be here a while, so I had better learn sooner rather than later.

Bluenomi Bluenomi 12:40 pm 18 Jul 12

$250 for a Ob/gyn is pretty normal. You can pay far more than that in Sydney and Melbourne.

Be thankful you get anything back. Visit a dentist and it can cost far more and you get nothing back from medicare

jimbocool jimbocool 12:15 pm 18 Jul 12

A specialist visit is usually much higher the first time – a initial consultation is a separate medicare item. Follow up consultations are usually much less. Obstetrican fees are stratospheric because their medical indemnity insurance is extremely high. Fees are also higher the further up the medical hierarchy you go – neurologists/neurosurgeons/cardiologists/cardio-thoracic surgeons are at the top and thus cost the most. Gastroenterologists are in the middle. GPs at the bottom.

If you have a regular need to see a specialist you should register for the medicare safety net – once you reach the threshold (there’s a limit on Obstetrics now) the medicare rebate is substantially higher.

pink little birdie pink little birdie 11:59 am 18 Jul 12

if you get a GP management plan it will bring down the cost significently. (but I think that only works for chronic conditions) It will also bring down the cost of the prescritions as well.

My specialist is in Sydney and is $180 with $70 back from Medicare. If the specialist is good I usually find it’s worth the cost of the out of pocket expenses. (even the 3.5 hour drive each way)

FioBla FioBla 11:54 am 18 Jul 12

My “helicopter view” is that it’s not expensive. Especially in a small town.

I just spent $132 on a plumber to repair a leaky tap. (This is after buying the tools and not being able to DIY). Money well spent.

Anyway, there are still GPs and specialists (yup, Cardiologists) that bulk bill in Sydney. Not saying you should go there, just saying that there is more competition over there.

I’m not yet as suspicious of specialist fees, cf vet fees, dental fees, lawyer/financial planner fees. And to be honest, regularly spending $10 for lunch seems quite extravagant—I don’t know how some people do it.

Live long and prosper.

By the way http://www.dendy.com.au/Promotion/Star-Trek-The-Next-Generation-25th-Anniversary-Event

nicnacvb nicnacvb 11:13 am 18 Jul 12

Nope. No safety net here.

I was really surprised! But not complaining……..

Mothy Mothy 10:38 am 18 Jul 12

See you one – Sounds about right from my experiences with the Obstetrician and Cardiologists for my wife and Gastroenterologists for me.

Raise you one – Now try the horror of $3,000 for management and planning of a pregnancy and getting $500 back from Medicare and nothing back from Private Health Insurance (they only cover the hospital expenses).

nicnacvb – those medicare rebates sound nice and high, I am assuming you have crossed the safety net?

Madam Cholet Madam Cholet 10:23 am 18 Jul 12

Have to agree. I have recently seen an ENT and whilst his fees were bearable with the rebate, I did feel that I was only ever going to get the 20 minutes they allot you and no more….not sure how they ever run late as I was in and out in the specified timeframe on both occasions. To boot, having booked in for an op it seems to me that there are very few surgeons/specialists who actually subscribe to gap cover. Why is tht? This op if I go ahead with it will cost me 2k out of pocket – that’s after the rebates.

Have to say though that when I was seeing an obs through my pregnancy I did hit the threshold and got almost everything back after a certain point. So instead of a run of the mill visit being about 80 dollars, it was only 20. Timed the conception and birth date just right to fit with the Medicare year obviously!

Back on specialists though….has anyone noticed that they all seem to employ Rottweilers as their receptionists? No one is going to get passed those ladies! The last specialist I saw had no email or web access in his office so you had to either take any paperwork in by hand, post it or god forbid fax it. Surely on their Salaries they can stretch to email?

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