Fees and costs in health care

Elisabeth BarryResolution OfficerHealth Care Complaints Commission

Public and private

Treatment as a public patient in the public health system (public hospitals and community health centres) is free.

Some people are eligible for treatment at public dental clinics.

If you see a doctor or other health service provider privately, there will be a charge.

Check with your private health fund about your cover for a particular service

Costs in the public system

There can be some costs even though you are a public patient in a public hospital, for example:

Special medicines that may not be available through the public hospitals

Special tests

ENABLE, the provision of wheelchairs and other equipment may require a contribution from the patient

Costs for ambulance service A person treated by an ambulance officer is responsible for

paying fees associated with their treatment or transport

It does not matter whether the patient requested the ambulance or not.

Some people are eligible for free ambulance and some private health funds cover ambulance services

Costs in private care

The government does not regulate fees charged for health care services by private health providers

Some health providers have professional associations that recommend fees. But, doctors may charge more or less.

Medicare

The Australian government sets a Medicare Benefits Schedule (MBS) fee, often referred to as the schedule fee.

Medicare pays a percentage of this fee – this is called the Medicare benefit.

Most medical services attract a specific Medicare Benefits Scheme item number.

Some services are not covered by Medicare or there are restrictions (e.g. eye examinations)

Doctors’ fees

A doctor is free to charge any amount for their services, they are not bound by the Medicare benefit

A doctor can choose to charge a patient only the Medicare Benefit amount ('bulk-billing‘).

The doctor accepts the Medicare benefit as the total payment. So there is no additional charge to the patient.

A doctor can bulk-bill all patients, no patients or some patients. The doctor may choose to only bulk-bill for some services.

Avoid unexpected costs

Don’t assume anything!

Ask about the cost first before agreeing to any procedure, tests or treatment

Clarify and confirm the total costs Be aware of cost for other services

Knowing the full costs

If your doctor does not bulk-bill, check with Medicare whether you can get a full or partial refund

If you have private health insurance, you should seek information about what your private health fund will cover and what you may have to pay yourself (the gap payment).

You can ask for a written estimate

Financial consent

When your health service provider gives full explanations about the fees and you agree to go ahead with the treatment, you are giving 'informed financial consent'.

But:

Cost could increase if there are complications in your treatment.

How to deal with surprises

If your bill is substantially higher than what was discussed, talk to your health care provider. If you still feel that the charge is unfair or

unreasonable, you need to communicate this.

Do not just withhold payments. Try to negotiate an agreement on how to pay

the account, for example, by instalments.

If you have difficulties

Private Health Insurance Ombudsman NSW Fair Trading Medicare Health Care Complaints Commission

Useful links

• Information on Ambulance Fees• Information on costs in public hospitals• Information on treatment through the public oral h

ealth services

Thank you.

For more information, visit www.hccc.nsw.gov.au