It pays to ask your surgeon for a cut

By Chief Advocate Ian Henschke

Late last year we conducted an advocacy survey. You told us your key concerns. The ever-rising cost of private health insurance, especially out-of-pocket costs, came through at the top of the list.

These payments, often referred to as gap payments, were the subject of last week’s 4 Corners on ABC TV and I urge you to watch it if you haven’t already (see link below).

I contacted the reporter, Dr Norman Swan, an old colleague of mine from the ABC when he was researching the program and told him some of your stories. Stories where people had paid for top cover all their lives when they were working and then had to pay out thousands of dollars in gap payments when they were struggling on pensions and fixed incomes.

We’ve made “Your Health” and health costs one of our top four advocacy areas. It was at the top of our 2018 federal budget submission. We called for a freeze on premium increases and reform of the system to deal with gap payments. In addition to sending this to every federal MP and senator, we have been talking to the body representing private health funds.

When I was in Canberra for the budget, I met Dr Rachel David, who is the head of Private Health Australia. We talked about fixing this problem. She features throughout the 4 Corners program and we agree with her that there should be a publicly available list of specialists and their out-of-pocket charges. This is so the system is transparent and you can choose to avoid a surgeon who is charging high fees and go to someone who is not.

Until that list becomes available when you get a referral to a surgeon, you should ask straight out what the gap payments will be.

It seems some patients are already losing patience with the system and doing just that.

This week a news report cited the case of a person who asked how much they would have to pay and was told the out-of-pocket payments would total $2500. The patient said they were unhappy and would go elsewhere. The surgeon then dropped the charges to just $400.

One conversation and the threat of going elsewhere resulted in a saving of $2100. This story shows why people are losing faith in private health. More people feel it’s not worth paying for if you must fork out for ever increasing premiums and high out-of-pocket expenses.

I contacted Dr David about the patient who stood up against the high charges and she said it was “amazing a patient had the wherewithal to tackle this with a surgeon”.

“Most people are too intimidated and vulnerable to negotiate (although I have a family member who did the same thing with a good outcome). That is why government-mandated transparency data is so powerful - it gives patients something to point to with authority that can give them confidence in dealing with providers.”

We will continue to push for lower costs and reform the system and have made this a key election issue in the upcoming poll.

Labor has already responded saying it will freeze premiums in the first two years and work to reform private health. The government heard our calls by granting the smallest increase in health insurance premiums for a decade in April this year and the Senate is conducting an enquiry into private health costs (see link below).

Another media report this week detailed an almost two per cent drop in private hospital cover in the past three years. Now only 45 out of every 100 Australians have cover. It doesn’t say the age group dropping out but our last advocacy survey revealed most of our members were considering dropping or lowering their health cover if costs continued to rise.

You can see Dr Norman Swan’s 4 Corners report by clicking here

Read our submission to the Federal Government Private Health Review by clicking here.

Read what National Seniors Health Insurer says about the Senate Inquiry and more by clicking here.

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