Dr Rachel David spoke to 5AA radio in Adelaide about the high fees some surgeons are charging patients for hip replacements

If you were listening yesterday, you might have heard a call from Alan. He was stunned when he had to have a hip replacement. Even though he had private health cover, he was still going to be thousands of dollars out of pocket. This is his story.

…anaesthetists is charging me a extra $500. They didn’t send me to a bulk billing x-ray unit so I had to pay for that, it was $389 and I got $84 back. Then when I wanted a copy of the x-rays and ultrasound, I had to pay for it, and I’ve got private health cover. I’m in disbelief. Sixty-four years of age and I had to pay, I would think by the end, approximately $9,000 more than my private health covers me.

Well look, I’m actually deeply troubled by what Alan had to say. Health insurers mostly strike no-gap fee and known-gap fee with doctors. And usually for a hip replacement you would be paying a little bit extra, but it’s more like $500 rather than 5,000. This is really not typical of what people are being charged out of pocket for hip replacements around the country. It sounds very high to me, and I’m wondering what he was told that was for.

Because what we are seeing in some pockets around the country is some side billing going on that’s occurring completely outside of the Medicare and the private health insurance systems, where people are being asked for these fees under the counter. It’s very hard for us or the Federal Government to keep track of it, and it really is not on in terms of the patient’s experience. I’m completely horrified that he’s had to encounter this when there are other doctors that would be prepared to perform exactly the same operation, which is a very good, very common operation for a lot less.

But the other thing that I think is interesting here is the drip pricing, that he was facing all of these different bills from different providers. And that’s something we’ve absolutely got to fix. I mean, it’s been going on for years. It’s just worse at the moment because there’s been inflation in some of these costs.

What we’re pushing for, and the Federal Government has said prior to the election that they’re open to reform, is for people to get a single quote before they have surgery or well before they have surgery so they have the chance to plan for if there are any out-of-pocket costs. Rather than the drip pricing that goes on, where it really is they’ve got actually no idea what they’re going to be up for until, sometimes, even after the surgery.

No. This is unusual and, unfortunately, if every surgeon did that and the health insurers were paying everybody an extra $5,000 whenever they did surgery, we’d have premiums going through the roof. So, what the Federal Government promised just before the election, which we’re very, very keen to support, is they’ve got a website called the Medical Cost Finder website. And they’re going to put all of the specialist fees up on that site so that patients have the opportunity to discuss with their GP what the potential cost is of surgery before they’re referred. And I think that’s really important.

Because if surgeons are indulging in this side billing, ie the bills that they’re charging patients in ways that the private health funds and the government doesn’t know about, then if the cost finder website says Dr X charges $500 out of pocket and then the patient receives a bill for $5,000, then they’ve got the ability to query it. Because this is a legal grey area.

And the other thing that we really want to encourage the Government to do is through the consumer law, which is managed by the ACCC or the Competition and Consumer regulator, we want to ensure that if people aren’t informed properly about their bills prior to surgery that they don’t have to pay.

Well, we’re- actually, we’ve had data from a number of sources now, a number of surveys and one most recently done by one of the universities in Victoria and the Patients Australia Association that suggests that one in five people who are referred to a specialist aren’t going because they’re afraid of the cost. Now, that is very, very troubling.

We know anecdotally from the hospital sector that some of these people are getting so sick they’re ending up in emergency departments. And the Medical Cost Finder website that the Government has proposed is going to be a very important first step towards addressing some of these concerns.

Because it helps people kick-start a conversation with their GP. I mean, some people get very embarrassed when they’re in front of a doctor to raise issues like cost. But I think it is very important to people, particularly in a cost of living crisis. And part of the discussion with the GP about a referral should be, well look, how much is this going to cost? And if I don’t go down this path, how long will I be expected- could I expect to wait if I decide to use a public hospital?

Look, I think sometimes this is made very difficult because people are put under some pressure. I mean, I have heard, anecdotally, from some of the high-charging specialists that often what happens is that they’re told, oh well, your surgery is already booked. You’ve got to have it otherwise, and you’ve got to pay me this money, otherwise you’ll lose the booking. I mean, all of that’s nonsense, really.

You do absolutely have the right for a second opinion based on cost. Unfortunately, it does mean another specialist appointment, which can be a couple of hundred dollars in itself. But the most important thing is that people talk to their GP first and mention that cost is an issue for them.

I think it would be well worthwhile that the particular caller, Alan I think his name was, to seek a second opinion. Because $5,000 is off the wall for a hip replacement. And I don’t know what- whether there was some complication or what excuse was given for charging that amount. But I’m pretty sure that if he was to see his GP and talk about a lower-cost specialist that that service would be available in South Australia.