Rightly, out-of-pocket costs are a major concern for consumers.

An out-of-pocket cost or ‘gap payment’ is the difference between the amount a doctor charges for a medical service and what Medicare and any private health insurer pays.

The Federal Government’s fee transparency website is a helpful tool to help private patients manage out-of-pocket costs.

The website publishes specialists doctors’ fees, giving consumers the power to compare costs and avoid getting ripped off by the small number of specialists who charge inappropriately high fees.

It can be used by GPs at the point of referral, to help patients avoid potential bill-shock.

Do you need to be referred to a specialist?

Visit the Government’s Medical
Costs Finder website to find
typical specialist fee costs

When it comes to price – higher cost does not equal better quality!

The training standards for Australian medical specialists are sufficiently high to ensure the vast majority are capable of providing high quality clinical care, regardless of what they might charge.

Australian law allows private specialists to charge whatever they want and health funds have no control over this.

Therefore, it’s important for consumers to ask specialists for an upfront quote, before surgery, so they understand the full costs associated with their procedure.

Tips to avoid out-of-pocket costs

Talk to your GP

So they can help you find a low charging specialist. Use the government’s new fee transparency website to find typical specialist fee costs.

Talk to your health fund

Most health funds have tools which list specialists covered by their GapCover schemes, who charge either no gap, or a known gap.

Ask your specialist

for a quote up-front which contains all likely out-of-pocket costs, including the anaesthetist, surgical assistant and diagnostic tests.

After surgery

If you have had complications or there are unexplained charges on the bill, do not pay it until there has been an explanation from your doctor.

Consider travelling

outside your immediate area to access cheaper options.