Helping customers to navigate and reduce out-of-pocket costs
Nearly half of all Australians have private health insurance - and there are several simple ways to make sure you’re fully informed before any in-hospital surgery or procedure.
Private health insurance is about choice – the choice of doctor, of hospital, and choice of time.
Dr Linda Swan, Medibank’s Chief Medical Officer, said being told difficult or distressing news can sometimes lead to people forgetting what they need to ask.
“I’d recommend patients plan ahead with a list of questions before a consultation. Every surgery brings with it the risk of complications, so you need all available information before deciding whether to proceed with what is being recommended,” said Dr Swan.
“You’re not second-guessing your doctor or questioning their expertise. It’s about making well-informed decisions about your own health,” she added.
Dr Swan said that if you’re unsure about a recommended treatment or cost, ask for a second opinion.
“Just because a particular specialist’s name is on the GP’s referral letter, this doesn’t mean you can’t take the referral to a different doctor. You may find different specialists charge very different fees for the same treatment or procedure. Paying more doesn’t mean you’ll get better quality of care.”
“The doctor’s office should provide an estimated cost breakdown. You can then determine what Medicare will cover, and where you’ll be out-of-pocket. If you have private health insurance, call the provider and check if they also make a contribution to the cost.”
Last year, Medibank paid a record $5.2 billion in benefits on behalf of customers. With requests of greater transparency, Medibank has launched an out-of-pocket cost calculator (Procedure Cost Estimator) where Australians can find out more about the cost of 45 of the most common hospital procedures.
“To reduce bill-shock, the calculator provides the likelihood of having out-of-pocket costs with an indicative range, what’s paid by Medibank and Medicare,” said Dr Swan.
TOP QUESTIONS TO ASK BEFORE SURGERY
1. Do I really need this test or procedure?
Ask your doctor for greater details on why they feel this test or procedure is best for you. Find out how effective this procedure is, and how long the benefits usually last. Ask if your condition may worsen — or improve — if you don’t do anything immediately.
2. Why are you recommending this surgeon to me?
Ask your GP for a selection of the recommended surgeons available for this procedure. Just because a particular specialist’s name is on the GP’s referral letter, this doesn’t mean you can’t take the referral to a different doctor. Ask your GP if any of these surgeons participate in schemes such as Medibank’s GapCover, which can help patients eliminate or reduce out-of-pocket expenses. GPs have access to this information on Healthshare.
3. What are the risks and possible complications?
Every surgery brings some risk of complications, so you need to understand how commonly they occur. Your GP may be able to discuss these with you, but the specialist will have the most information.
4. Are there simpler treatments or safer options available?
This could include making some lifestyle changes, such as eating healthier foods or exercising more. Discuss this with your GP when you get a referral to a specialist.
5. How much will this cost?
Get a detailed breakdown of fees at the initial consultation with the specialist to avoid any unexpected out-of-pocket expenses. There can be a wide scale between what surgeons charge, but paying more doesn’t necessarily mean you’ll get a better quality of care. Ask about the fees that each health professional in the team will charge, such as the anesthetist or an assistant surgeon. If the figure quoted sounds unreasonably high, call around to get a better idea of what is a fair price. Ask whether your specialist participates in schemes such as Medibank’s GapCover, which can help patients eliminate or reduce out-of-pocket expenses.
6. Will my current lifestyle and health impact possible treatment?
Be honest with your GP and your specialist. Discuss whether you have any risk factors, such as obesity, smoking or diabetes, which might increase the chance of side effects or complications.
7. What experience do you have with this procedure?
Take some notes when you visit the specialist so it’s easier to remember what you discussed, especially if you’re seeing another specialist/s for a second opinion. You may like to ask: how many times have you performed this surgery? How regularly do you do it now? What is your complication rate?
8. Will I need to stay in hospital and what will my recovery be like?
Ask the specialist how long you may need to stay in hospital, what are the best available hospitals, and how long you’ll need off work. Ask what rehabilitation or follow-up is required, or if you’ll have restricted mobility in the weeks or months after surgery.
9. What does my private health insurance cover?
Call your private health insurer to find out if you’re covered for this procedure, and ask your specialist if they charge any additional out-of-pocket costs. Ask if your specialist participates in schemes such as Medibank’s GapCover, which can help patients eliminate or reduce out-of-pocket expenses. Specialists can charge very different out-of-pocket costs and many don’t charge extra fees at all.
10. How can my private health insurer help me post-procedure?
Medibank can assist eligible customers to recover from surgery with support ranging from free transport assistance to mobility aids for the home through our Health Concierge program. If you’re having a knee or hip replacement you may be eligible for rehabilitation in your home. Give Medibank a call to discuss your options before you go into hospital.
Media enquiries
Mia Greves on 0417 420 227 / mia.greves@medibank.com.au