Retirees urged to reveal horror medical gap costs

Consumer advocates to tell Minister how much Australians pay in medical gap costs.

Retirees urged to reveal horror medical gap costs

Australians are risking their health by avoiding medical care because of rising gap fees, according to advocacy group Consumers Health Forum of Australia (CHF).

The forum has invited the public to share their stories about being frozen out of medical treatment or stung by rising gap costs. It intends to submit case studies about the crisis facing consumers to a ministerial advisory committee on out-of-pocket medical costs.

As reported in The Australian last month, research prepared for a different committee – looking into health insurance – indicated the highest total out-of-pocket costs are for hip and knee surgery, urology, and ear, nose and throat surgery. “The largest averages being for spinal, bariatric and brain surgery.”

The CHF is the only consumer representative on the gap-fee ministerial advisory committee. It hopes that responses received in its “out-of-pocket pain” survey will build a convincing case for the creation of an official government website that allows patients to compare medical fees and performance between specialists.

 “Now is an ideal time for people to have their voice heard on this vital issue and relayed to the Government,” CHF chief executive Leanne Wells said.

“Many Australians experience an added setback when they undergo medical treatment with many receiving large bills that are not covered by either Medicare and/or private health insurance if they are insured.

 “In recent weeks the fresh revelations of these high out-of-pocket costs whether they be gap medical bills for a specialist consultation outside hospital or for a procedure performed in hospital, have underlined the costs issues that are eroding access to health care in Australia.

“Not only can people face additional costs of thousands of dollars for a routine operation, official surveys have found striking variations in fees charged, generating confusion and uncertainty about the overall costs facing people opting for private care.

“We need to see a clear picture of the reality of costs facing health consumers and the impact they are having on access to health care. Australia has prided itself on the performance of our health system, its universality and its unique public/private mix.

“We fear we are getting close to the point where we can no longer make that claim. Increasingly, people are choosing public hospital care to avoid the out-of-pocket costs billed by specialists in private hospitals.  This is causing strains in both public and private care and will continue to do so if the trend is not arrested.

“And outside hospital, among insured and uninsured people there are now many who are putting off seeing specialists they have been referred to because of the costs. Nearly half of the respondents 45 years and over to a major national co-ordination of health care study said that the cost of the appointment was a reason they did not see a specialist doctor when they felt they needed to.

“CHF has proposed the establishment of an authoritative website which carries fee and performance details of all specialists. We hope that a strong response to the Out-of-Pocket Pain survey will ensure urgent action,” Ms Wells said.

To complete the survey, go to

Have you ever been caught out having to pay high out-of-pocket medical costs? Has having private health insurance saved you gap costs? Should health insurers be obliged to pay the full cost of procedures they cover, such as car insurers do?



    To make a comment, please register or login
    19th Jan 2018
    I I've had private health cover for over 39 years. When I dislocated my wrist the surgeon asked for $2000 before even examining me. That was about 8 years ago. The same year I had my first knee replacement. No gap. 4 years later I had that knee replacement repaired dUE to an infection in the new joint, again no gap. 2 years ago I had open heart surgery, $5000 gap required. I had just lost my husband and money was tight, but it had to be done. I don't think there should be a gap, I've never met a surgeon or specialist who has a nice upmarket house, car, holiday, whatever. The health funds pay them handsomely. My children insist I keep my health fund going, I can just afford it. The public system is brilliant, but waiting times are important when you are suffering.
    19th Jan 2018

    19th Jan 2018
    I'm in the public system only. I'm not here to make the doctors and dentists and insurance companies rich.

    If any particular waiting time in the future results in my death, so be it.
    19th Jan 2018
    Yep, I´ve been with private Health Ins for many years but after experiencing hardship by having to pay gaps to Drs. tests and
    Hospitals and I´m to keep only extras, next time. Private Hospitals are the worst following specialists. They just focus in making billons...thanks to the Liberalism principle.
    19th Jan 2018
    The health insurers' greed is slowly guaranteeing its demise, as more and more dupes see the light and bail out.
    19th Jan 2018
    Thankfully I now have a DVA Gold Card for which I have paid no gap for any treatment, so far. I have never had to use it for anything serious or hospitalisation but all the specialists, and my dentist, I am referred to for my minor ailments accepts the Gold Card as full payment. Not so for my wife who is under Medicare, we still have out-of-pocket expenses for specialist consultations. Not being OAP does not get us any concessional benefits either despite both being in our 70s..

    19th Jan 2018
    I had surgery twice and copped huge gap costs - in the thousands. One of the operations was in a private hospital and the standard of care was nothing short of appalling. When I left hospital, I was very ill. I went to the doctor for a follow-up consultation and he refused to see me because I hadn't paid his bill. I had my cheque book with me. I hadn't paid because I'd been so ill. He would not accept my explanation. When my partner asked if it was normal to be so sick after the surgery, or should we worry, he replied ''I'm not going to answer that because I have refused a consultation.''

    I went elsewhere and found I had complications from botched surgery. The doctor asked if I would prefer to go public for the corrective surgery. I did, at zero cost, and had fantastic care. It was almost unbelievable how much better it was. I did have to wait 6 weeks, as opposed to 8 weeks for the private hospital. I withdrew from private cover in response.

    Now my partner and I are faced with an estimated $60,000 out of pocket cost for eye and dental treatments. Insurance would not have covered these anyway as the annual limits are ridiculously low. We cannot find a specialist who will recognize a concession card or accept the fee recommended by Medicare. It's a case of pay or suffer. At least we've saved some $15000 in medical insurance, and an unknown amount in gap fees because we've used the public system for the past decade - and found it excellent.
    19th Jan 2018
    What an appalling experience, Rainey. See my comments below...

    We live in an increasingly heartless, greedy society.
    19th Jan 2018
    Sounds familiar Rainey, went into one of St John of God private hospitals for a prostate cancer operation and as a bonus they gave me pneumonia. It was touch and go to be transfered to a public hospital for further treatment. Remained in the private hospital on antibiotics via a IV pump and during the night the butterfly needle came out. The nurse that attended REFUSED to put it back in because she did not like giving pain to a patient? I discharged myself immediately and asked for all my records. Went to my local Dr who dealt with my condition.
    I then ended my private health cover and when my late wife developed cancer I did worry having no private insurance but the Public Health Hospitals and Specialists gave immediate and full treatment AT NO COST. I actually saved money from being out of Private Cover and treatment received. Since being out excellent public hospital cover. The only advantage of not feeding the shareholder $$$ 's s would be for hip,knee replacements etc: and if you put a small amount of money away each week you would cover any non urgent operation. I would also suggest that if you have private cover and going to hospital on a top priority you do not tell the hospital you have private cover. Your treatment at the hospital is priority and it costs you nothing.
    ray @ Bondi
    19th Jan 2018
    I dropped out of my fund years ago (it is not insurence, insurance provides proper cover). I had a small operation, which cost about $1000, after Medicare rebate and my fund refund I was about $600 out of pocket, it was then I decided it was nothing but a wast of money, sadly public hospitals are being rung down to support the private health industry, it is a disgrace that all governments are guilty off.

    19th Jan 2018
    I'm deeply unimpressed by the medical profession - particularly specialists - and their financially rapacious ways. Most doctors I've encountered are arrogant and ignorant: they are frequently unable (or unwilling) to answer even basic questions.
    20th Jan 2018
    Interestingly, Knows-a-lot, I find the doctors who only bulk bill are dedicated and knowledgeable. I'm always amused at affluent folk who say they go to expensive specialists because they want the best care. Seems to me those who focus on lining their pockets actually don't give a hoot about the patients.

    19th Jan 2018
    The (health) insurance sector needs a Royal Commission into it - one that is broad, deep and with binding outcomes. Insurance is a SCAM.
    19th Jan 2018
    I have had private health cover for at least 45 years and am seriously considering if it is worthwhile. Now I'm in my 70's it scares me to drop out but when I had surgery just over a year ago my out of pocket costs were $5000. I just can't afford bills like this anymore. It's pretty unfair when you pay around $4,000 every year for private cover that you have to pay so much out of pocket. There really should be no gap for people who have continued paying for private cover for so many years.
    19th Jan 2018
    I am 63 and have had health insurance since I started work at 16. In all that time I have had 2 operations - tonsils and appendix. Now my partner and I are still paying and if it was up to me I would opt out but he insists on keeping it. It is tough now while he still has a job (I am unemployed) so I can't fathom how it will be when he retires or loses his job as I did. It's very scarey thinking about it.

    He had a minor day surgery a few months ago and we had to give the surgeon $500 before she'd even look at him and 2 appointments at $95 each, plus pay $250 excess, for a 1 hour operation. It sucks!
    see all.Maryakate
    19th Jan 2018
    Any Insurance company provides a service for one thing only. Profit. We joined Medibank Private when it first started, and we received a fair return. Then as we got older and Medibank was sold off, the cost went up and the rebates went down. All these insurances should be under Government control, for as we know Australia has an aging population and people's funds are being eroded. But the Government wants you to keep paying for your own cover.
    20th Jan 2018
    A Suncorp customer service rep, when discussing a policy I was interested in, told me ''We don't cover valuable electronics or cameras. They get damaged or stolen too often. We are in the business of collecting premiums, not paying out!''

    I guess those running medical insurance funds have the same attitude.
    19th Jan 2018
    I worked as a specialist in private practice for 24 years before moving into a teaching/public hospital role. My patients in private were charged the schedule fee only, so no gap. We comfortably raised a family on the proceeds. After retiring I have been on the receiving end of the extortionate gap-in-advance tactics others describe. In regional areas things are worse when the few local specialists are all charging gap fees like wounded bulls, and you either pay or go hundreds of Km to the city.
    I am deeply ashamed of the bad eggs in medicine who are driving the privately insured battlers to the financial wall. One of the tenents of medical professionalism - which I used to teach - is placing the patients interests before your own. Obviously this is being ignored out of hand now. It is high time that the gap fee rip-off was brought to a juddering end.
    20th Jan 2018
    Nice to hear that some in the medical profession have integrity, Bellbird.

    I have heard dozens of nurses say they moved from hospitals to public because they wanted to actually nurse patients, not make greedy corporations rich by cutting corners and leaving patients unattended. They also said they were hideously overworked in private hospitals because the greedy corporations refused to hire sufficient staff. What an appalling state of affairs when someone can open a private hospital and pretend to offer better care to people who can pay more, but actually deliver worse than is offered in the public system!
    19th Jan 2018
    how can you blame some of these doctors and specialists wanting such high pay when the CEO of QANTAS gets over $10,000,000 million a year and who a few years back stopped all flights and left passengers stranded all over the world. And just 2 days ago Qantas 'worst major airline' for fuel efficiency on trans-Pacific flights. So Joyce will earn another 5 mil when his fixes this, and more Qantas work will go overseas
    29th Jan 2018
    I recently visited an HBF office to claim a gap rebate only to be told that I had a number of previous procedures/dentist visits with gap benefits which I had not claimed. When asked if I could claim them then I was told I needed to bring in paper invoices etc. All the necessary information was on their computer listing items charged and paid for and the gap benefit payable to myself - why is it that I cannot get paid the gap withoug having to go through this procedure? Just paid $2,211+ and expect to pay more in April!

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