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

By 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?

What’s Your opinion?


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23 Responses to
Exorbitant specialist fees in Canberra … what’s going on here?
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 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 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 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 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 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 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 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 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 11:13 am 18 Jul 12

Nope. No safety net here.

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

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 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?

nicnacvb 10:07 am 18 Jul 12

I have recently started seeing a gastroenterologist and a cardiologist. They are both really good at what they do and came highly recommended.

The cardiologist charged me $220 for the first appointment and I got $180 back from Medicare. It was about $320 for the second appointment with an ECG and I got back about $250 from Medicare.

When I made the first appointment with the Gastroenterologist the receptionist told me the consultation would cost $140 and I would get back about $120 from Medicare. But when I went to see him I said I was a bit concerned about the cost of procedures etc and so he reduced the fee to $74 without me even asking. I have seen him 3 times now and only paid $74 each visit and I get about $60 back from Medicare. That’s cheaper than visiting a GP!

Do you have a referral from your GP? If not you probably won’t get anything from Medicare. And make sure you inform the specialist of your concerns about cost. They may actually give a damn.

I’ve certainly been pleasantly surprised with the fees and rebates.

beejay76 9:12 am 18 Jul 12

I saw a cardiologist recently and that was around $300. Although, that included an ECG, about 20 mins with the cardiologist, and a follow-up appointment of about 15 mins. My daughter sees an ophthalmologist and that’s about $200-odd, I think. Unfortunately I have no comparison as I’ve never seen a specialist before I lived in Canberra, but the prices you quote are consistent with my experience here.

Rollersk8r 9:11 am 18 Jul 12

I hear you. I’m currently seeing 2 specialists for minor things that were picked up by the GP. Have paid around $2000 for tests and treatment in the last couple of months.

The thing that gets me is the $260 I paid to the blood specialist, only to be sent away for more tests that I have to pay for. Why not request the tests BEFORE I see you? Now I’ll have to pay another $200 odd to hear the results…. There had better be something seriously wrong, otherwise it’s terrible value for money 🙂

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