ABC Radio Adelaide program interview with Ben Harris on surprise billing undermining the value in health insurance for consumers

Station: ABC Radio Adelaide
Program: Mornings
Date: 19/07/2021
Time: 9:06 AM
Compere: David Bevan
Interviewee: Ben Harris, Director of Policy and Research, Private Healthcare Australia


DAVID BEVAN: Have you ever had bill shock with your doctors? Now, the Private Health Care Australia is arguing that surprise billing is undermining the value in health insurance for consumers. I’m reading from a piece in today’s Australian. It says insurers want the government to introduce a criminal offence aimed at fining doctors who seek to hide medical costs through split billing, where a full cost of the service is not disclosed to various payers. So, it might be you as an individual, your private health insurance scheme, and maybe the taxpayer. So, who’s hiding the money? Ben Harris is Director of Policy and Research at Private Healthcare Australia who joins us now. Good morning Ben Harris.
BEN HARRIS: Morning David. How are you?
DAVID BEVAN: Good. What does Private Healthcare Australia say some doctors are up to?
BEN HARRIS: Well, about 10 or 15 years ago, surprise billing was the norm. You’d come in and you wouldn’t quite know what sort of bills you are going to get and how big the gap was going to be. Over the last decade or so, the Australian Medical Association and the health profession generally have done an outstanding job to drive down surprise billing. So, we are now at the stage where less than two per cent of bills have a no- sorry, less than two per cent of bills have an out-of-pocket cost that is not known to the patient beforehand. Now, that’s been a great effort, but there’s still some bill- some doctors out there who are splitting bills or giving people bills they are just not expecting.
DAVID BEVAN: [Interrupts] So can you give us an example? Somebody who, what, goes in for a hip replacement? Would that be a good example?
BEN HARRIS: Yeah. So, hip replacements are very common. A great- really good for people to get rid of pain. And you may receive a bill from your surgeon. You could also receive a bill from the surgeon’s assistant, or pathology, or an anaesthetist, and in some- most of the time, doctors, hospitals, and health funds work together to make sure people know what they’re up for. However, there’s a very small number of people who receive a bill they’re just not expecting. Now, that could be a bill from say, an anaesthetist where they weren’t expecting a gap fee. It could be that a doctor has split the bill and told the health fund- asked the health fund to pay some, asked Medicare to pay some, and then send a separate bill to the patient. It might be the booking fee, or an administrative fee, or some other fee which is designed to split the bill. Now, our view is that medical care is occasionally complicated, but more than 98 per cent of the time you get what you’re expecting. So, private healthcare billing should be no surprises. Patients should only pay a gap where it’s been disclosed beforehand.
DAVID BEVAN: Right. So, none of this: oh, I realised we’d need an anaesthetist to knock you out before we did the operation. How did that slip my mind? Or, heavens to Betsy, I’ve realised I’ve got a secretary here who needed to send you out a bill. I forgot completely to put that in.
BEN HARRIS: Look, there should only be an unexpected bill where there’s an unexpected service. Now that happens about two per cent of the time in hospitalisations, and a lot less in the private sector. But really, what we’re proposing is simple. If you get a bill you’re not expecting, you’re not liable for anything more than the MBS fee.
BEN HARRIS: No gap payment, unless it’s disclosed beforehand.
BEN HARRIS: So, the doctor will still get paid.
DAVID BEVAN: Yeah but they’ll get paid the standard fee.
BEN HARRIS: That’s right.
DAVID BEVAN: Okay. Dr Michelle Atchison is with the AMA, State President. Good morning Michelle.
MICHELLE ATCHISON: Good morning David.
DAVID BEVAN: Is this a good idea?
MICHELLE ATCHISON: Oh, look, I absolutely agree with everything that Ben has just said. We, in the AMA, are absolutely for what we would call informed financial consent. So, if you’re going to have an operation or an episode of care in hospital, that your doctor informs you what the costs of that will be before you come to hospital, or if it’s an emergency, as soon as obviously is practicable, and that you know what the gaps are, you know what the charges will be, you know how you’ll be able to charge that. So look, we would absolutely agree with Ben that it is not good medical practise to- for the poor patient to end up with a bill that’s completely unexpected, and that doctors should be informing their patients about the cost of any services in hospital.
DAVID BEVAN: This will require federal legislation just to- I mean, Ben Harris is saying it’s a small number of doctors who are doing it, but in order to clean up the last remnants, it’ll need federal legislation. Is that correct?
MICHELLE ATCHISON: I think that was what Ben was suggesting. I’m not sure that legislation and criminal charges are the way to go in this area. My view, and the AMA’s view, would be that patient education is really where the money is at the moment. So, you as a patient going into have a service, you need to know that you should ask, what’s the cost going to be, doctor? You know, what are the other costs that hang around it, just as Ben said, about perhaps anaesthetist costs or pathology costs or radiology costs. So, you need to be asking those questions off your doctor when you are booked in for an episode of care in hospital. So, I would see that putting the emphasis on educating the public, knowing that this is a very fair question to ask, that- you know, you have every right to ask what it’s going to cost. And if it cost- if the costs are unexpected, you have a right to a second opinion and another cost if you like. But, I’m not sure that criminalising the behaviour is the way to go.
DAVID BEVAN: Alright. Ben Harris, private- from Private Healthcare Australia, is an education program the answer, or do you say, no, look, we’ve been on this for years, and they’re still a remnant of doctors who are doing the wrong thing, we need some teeth in this.
BEN HARRIS: Look, Dr Atchison’s just given a really good example of the leadership of the medical profession on this. They’ve been really, really clear over many years with many presidents of the Australian Medical Association at the state and federal level that we need to make sure the patients are looked [indistinct]. However, we do have a stubborn group of- group at the end of the line who are still giving surprise billing. In the United States, we’ve got legislation in 34 states now, which say that if you get a bill you’re not expecting, you don’t have to pay more than the standard fee. It’s quite a simple change. And, you know, basically, it’s one of those things where if there’s a fine involved for doing the wrong thing and splitting a bill, then that should discourage the behaviour. Certainly we wouldn’t want to see anyone paying that fine. Everyone is much better off if you’re open and transparent about the fees.
BEN HARRIS: [Interrupts] But the point Dr Atchison makes around patients asking, I think, is important, and we need to make sure that everyone who goes to see the doctor is empowered to ask about fees, and that doctors are really getting well educated, as they are, about discussing fees with their patients.
DAVID BEVAN: Alright. Texts coming in on this. Sally from Adelaide says: I saw a consultant who used some equipment to examine me. I expected to pay around $200 out of pocket, but there was no discussion about costs. I walked away $400 lighter. I’m still astounded that part of that bill was $25 for swabs. So she’s not too impressed. And another listener says, my medical bills always have a charge for a wounded bull. Thanks for your text and your calls. Ben Harris, thank you for your time.
BEN HARRIS: Thank you David, and thank you Dr Atchison.
DAVID BEVAN: From Private Healthcare Australia and before that, Dr Michelle Atchison, State President of the AMA.
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