How to choose a medical specialist

19 February 2020
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This content is brought to you by National Seniors Australia partner, My Dr Bill.

Making an informed choice

Your GP will recommend you see a specialist but remember you can choose which specialist you want.

You can also ask the GP what they know about the specialist including their experience, manner and results, and how much they charge.

Ask the GP to recommend a couple of other specialists so you can undertake your own research.

Here are some additional sources of advice:

health funds – they often have lists of doctors on their websites
family and friends – especially if they work in healthcare
Hospitals – if you want to go to a private hospital you will often find a list of specialists who are accredited at that hospital on their website.

Out-of-pocket costs

Doctors’ fees are complex.

It is very easy to get bamboozled by terminology around the Medical Benefits Schedule and health fund rebates (whether No Gap or Known Gap).

What matters to you is the Out-of-Pocket cost (OOP). In other words, what you will have to pay for the medical service.

To know your likely OOP before choosing a doctor is your right, but it can be difficult to find.

Here are some suggestions:

Ring the specialists’ office

Make it clear that you are looking for a fair approximation of the OOP, not an exact figure. You may need to ask follow-up questions to get the information you want.

Step 1

Tell the receptionist your name, your referring GP and the procedure the GP thinks you need. Mention that you have been given a few doctors’ names to consider.

Say which health fund you are a member of, your level of cover and whether you are a pensioner or Health Care Card holder.

Step 2

The most important question is:

What is my likely OOP cost for this operation?

If there’s no useful answer:

What does this procedure usually cost your patients OOP?

If the answers refer to private health insurer fund levels, you might have to ask:

Does the doctor ever use No Gap or Known Gap arrangements with private health insurers?

If yes:

Does that usually mean there is no OOP?

If yes:

Will that apply to me?

If yes:

Does this mean I will not be asked to pay anything else above the No Gap or Known Gap levels? (e.g. Booking or other upfront fees)

You will now probably have a fairly good idea of what the specialist will charge you. It’s time to ask about the rest of the costs.

Step 3

The specialist usually chooses which anaesthetist does his/her lists. The surgeon usually has little say about what the anaesthetist will charge and may not even know.

It is important to ask:

Will an anaesthetist be needed?

Can you tell me what his/her charges are likely to be?

Does the doctor use some anaesthetists who charge less than others?

Would I be able to get on the operating lists that they do?

Can you give me the anaesthetist’s contact details?

Step 4

Ask the following:

Will an assistant be required?

Can you tell me what his/her charges are likely to be?

Step 5

Other costs: